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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 a nnmc�nC�S (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 t MCC rh CL —t 2. FOC r 1 bay MCI n M V20 C i f►'1_ 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 qj ,3qJcO U J L PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 11W6) MILEAGE CLAIM 1 Q i e S l k o" �J mO CV (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, n 1 9 AL met- 7 rn o nn c A I AN 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 H i JL y 4 1011, 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 L L 1 J�Q CL 1 a rn C l c In C, 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