HomeMy WebLinkAbout201007 08/30/2011 CITY OP CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $124.32
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46616 CHECK NUMBER: 201007
CHECK DATE: 813012011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 124.32 TRAVEL FEES EXPENSE
PRESCRIBDD BY STATr BOARD Or ACCOUNTS GERFPAL FORL 14G. 101 MUM
MILEAGE CLAIM
To
(GOVERHKENTAL UNIT)
ON ACCOUNT APPROPRIATION NO- FOR
(Or7CE, BOARD. DEPARTIO t OR INSTrrIRION)
SPEEDOMETER AUTO ]MILEAGE
DATE FROI"I TO READING WLES
2 POINT POINT START FINISH NAT(JRIi OF BUSINESS TRAVELED
PER MILE
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AUTO LICENSE NO- TOTALS G j f 1 55 c
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. ✓GA `q' l
Pursuant to the provisions and penalties of Chapter 155, Arts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after atiowing all just credits r
and that no part of the same has been paid.
Date
PRESCRIBED er STATE BOARD OF ACCOUNTS GENERAL FORM NG. 101 11996)
MILEAGE CLAIM
TO a ty M
4GOVLANMENTAL UHIS1
ON ACCOUNT OF APPROPRIATION NO- FOR
to"CE, BOARD, DEPARTImrr OR 1"nTruncs)
SPEEDOMETER TI)
MMEAGE
DATE FROM TO I READING NATUR
r OF BUSINESS IyQi S Y
POINT POINT START FINISH 1'AAV£S.- PER MILE
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AUTO LICENSE NO. TOTALS h., -°r
SPEEDOMETER READING columns are to be used only 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 isie y due, after allowing all just credits
end th o pa of tile sa a has been paid
Dale
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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
8/9/11 Reimb mileage 7/1 8/1/11 124.32
Total 124.32
I 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
124.32
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 Reimb 4343000 124.32 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
23 -Aug 2011
�Ck'h.�.�rrmQh
Signature
124.32 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund