HomeMy WebLinkAbout165957 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
0 ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $116.42
(q. CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 165957
CHECK DATE: 11/1212008
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUM BER AMOUNT DESCRIPTION
1046 4343000 116.42 TRAVEL FEES EXPENSE
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GENERAL FORM NO. 101 (1986)
BED
'VRESCRI BY STATE BOARD OF ACCOUNTS
MILEAGE CLAIM r
TO—
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTIT QN)
DATE FROM TO SPEEDOMETER.
READING AUTQ MILEAGE
o�� POINT POINT START FINISH NATURE OF BUSINESS TRAVELED PER MILE 4
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AUTO LICENSE NO. TOTALS 1
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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 is legally du after allowing all ju t credits,
2nd that no part of the same f has been paid.
Date A I v•
I (cp_T 3 D
OCT 2 8 2008
r'. CRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
E MILEAGE CLAIM
TO
(GOVERNMENTAL' UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS l
l V1
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 is le lly d e, after allowing all 'ust credit
end that art of th sam has been paid.
Date -r
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must knumbeservice,
of lunits, where ates service rendered, by
price per unit el
w rates per day, number of hours, rate per hour,
Payee Purchase Order No.
Terms
359285 Simmonds, Valeska Date Due
invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) 116,42
9125108 Reimb. Mileage 9!5!08 10117!08
Total 116.42
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Simmonds, Valeska Allowed 20
V �t TID 35828
In Sum of
116.42
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 116.42 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
31 -Oct 2008
Signature
116.42 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund