164436 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
0 ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $102.96
ANDERSON IN 46016 CHECK NUMBER: 164436
CHECK DATE`. 9/30/2008
DEPARTMENT ACCOUNT PO NUMB INV OICE N AMOUNT DESCRIPTION
1046 4343000 102.96 TPAVEL FEES EXPENSE
r
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (19sq
MILEAGE CLAIM 1
TO vs
(GOVERNMENTAL' UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
i
(OFFICE, HOARD, DEPARTMENT OR INSTTTUuoNj
DATE FROM TO SPEEDOMETER AUTO MID
REA DING GE
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED
PER MILE
M Yin C
i 0 L i�1 C n- f e� w ®Y
i
J fyr 1t
y y JiL� j i r /',1
i'Y1L 1 0 5-2(08
-or o rroL 5
hL !f I
i
AUTO LICENSE NO. TOTALS t
SPEEDOMETER READING columns are to be used only when distance between- point8 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 due, after al wing all just credits
end that no pa t of the same has been paid.
Date lit I f An E
f
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (2986)
MILEAGE CLAIM C a
TO (GOVERNMENTAL'UNTT)
ON ACCOUNT OF APPROPRIATION NO. FOR
i
(OFFICE, BOARD, DEPARTMENT OR INSTTTU'rION)
a'
SPEEDOMETER.
I]ATE FROM TO READIN G f AUTO GE Y
NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
_t e I
MC
rl. 1 6�?r rn i= is L: u S�: p� am
1 i
r C 0MC
ra �p TM Q 5Cl
Y J
C I I 5 YU 5 X
FS -D L C'
3
r
AUTO LICENSE NO. TOTALS
f SPEEDOMETER READHgG columns are to be used only .when distance between points cannot be determined by fixed mileage or official highway map. ll
Pursuant to: the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account �ust�'and correct, that the amount claimed is legally due, after allowing al us redits
and that no part of the sarn has been paid.
Date
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
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9!2108 Reimb. Mileage 811/08 8131108 102.96
Total 102.96
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
2 a,—
Clerk- Treasurer
Voucher No. Warrant No.
Simmonds, Valeska Allowed 20
In Sum of
102.96
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 102.96 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
15 -Sep 2008
V Signature
102.96 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund