HomeMy WebLinkAbout200109 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE,., SIMMONDS
!i 3 CHECK AMOUNT: $133.11
CARMEL, INDIANA 46032 2703 E LYNN ST
ya ANDERSON IN 46016 CHECK NUMBER: 200109
CHECK DATE: 8/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 133.11 TRAVEL FEES EXPENSE
P GENLRAL FORM NO. 10) (IW6} Rr5CR76CP HT SLATL 90AAO OF ACCOUNTS MILEAGE CLAIM
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(GOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO- FOR
(OKICE, HOARD, DEPARTWM;KT OR INST=ION)
FROM TO SPF-EDOMETER AUTO UtLEAGE
DATE MILES
Za ]RAVELED HEADING NATURE OF BUSINESS r
POINT POINT START PINfSH PER MILE
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AUTO LICENSE NO. TOTALS 1
SPEEDOMETER HEADING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. q 1, C
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that no pa,x4 of the same has been paid.
Date
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 11W6)
MILEAGE CLAIM
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(GOVERNMENTAL UNm ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,ICE, BOARD, DVAAT144T OR 1NST MION)
FROM TO v SPEEDOMETER AUTO MILEAGE
DATE I READING
2b NATURE OF BUSINESS r
POINT POINT STRR7 FINISH TRAVELED PER WL,
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AUTO LICENSE NO. TOTALS I
SPEEDOMETER READING columns are to be used Daly when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legal] due, after aliowing just credits
end that no p T1 0l the same has been paid.
Dat
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PRESCRIBED HT STATE BOARD Or ACCOUNTS GENERAL FOAM NO. 101 11963)
MILEAGE CLAIM l min Ldtskp�
(GOVERNMENTAL UNm
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DF.PARTMEXT OR INSr=ION)
FROM TO i SPEEDOMETER AUTO MILEAGE
DATE l READING
Z° LL POINT POINT START FINISH NATURE OF BUSINESS TRAVE ED r
PER MILE
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AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. L 0,
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowiA all just credits
end that no pap of the same has been paid.
rUUIY( /OJT
Date ICS`
4
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
359285 Simmonds, Valeska Terms
2703 E Lynn St Date Due
Anderson, IN 46016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6130111 Reimb Mileage 5/16 6129/11 133.11
Total 133.11
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
i
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of
133.11
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 133.11 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
26 -Jul 2011
Signature
133.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund