163402 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 2703 E LYNN SF CHECK AMOUNT: $258.46
ANDERSON IN 46016 CHECK NUMBER: 163402
CHECK DATE: 9!3!2008
DE PART ME NT ACCOUNT PO NUMBER I NVOIC E NUMBE A MOUNT DE
7;046 mm 4343000 X 258.46 TRAVEL FEES EXPENSE
i
I
PR$SCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 161 (1986)
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 5 J x
0 a ao 7 POINT POINT START FINISH TRAVELED PER MILE
mAC
Y
r_ L
L�
Q w
0 -POE Oct ��f
r1'►�1 CA nA o
t~ L X 7r—osrQ rn w C�
OL
e T
C_ 1 200 G
QrQ C"M
AUTO LICENSE NO. TOTALS i Q5
SPEEDOMETER LEADING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. r
1
Purs ant 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
znd that no part of the same has been paid.
0 Date _T�
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL' UNTT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER. AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES 52,S 0
it POINT POINT START FINISH TRAVELED PER MILE
C v►ti
'Wr C I A M 5
o LF M Cr M ec-4-c),
Rot: rv) e
v cr i i- 6 b
1400>4 rv\
C u A'1 3
Co u.r
v e1
Ch Gc k Pt O
u1 calms
-t
4
u ort— 3
✓1A tJ lam C J I /►.I/
j h/1
tA 1,n
S cv, rr-v
1
LJ C
r AUTO LICENSE NO. TOTALS uI �i l or
SPEEDOMETER READING columns are to be used only .when distance between points cannot be determined by fixed mileage or official highway map. -0 1q
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
2nd that no art of the same has been paid.
Date
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM SIc y
J� Sys
(GOVERNMENTAL' UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING
0 IQL POINT POINT START FINISH NATURE OF BUSINESS TRAVELED IL MILES
P MILE
15 e l' �e-
TS UM A1W a I)AD 'QrQQM 0
C a I)'
INI rn cr
ryl
e
J
r r
'M
11
p "1
�J
Pl G.2Q ?a
f7 q cwt
PAr CA, r1.4
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.
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 part of the same has been paid. �v S 29 D ate t �l V A
I2RESCRIBED4BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIir1
TO y&4
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING It
MILES 0 �Q POINT POINT START FINISH NATURE OF BUSINESS TRAVELED 50.5
PER MILE
Lo is K
LJ cal'
o c
M
L nn
5
r
I Al
C
0-\
I FO ryl C v o- r
L L
�C
1
k
L- AUG 1 1 7008 I
r -3 L. C
c� L
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between- points cannot be determined bv. 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 allowing all just credits
end that no part of the same has been paid.
Date �C ��1 �^1^ A
.PRESCRIBEID BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL' UNTT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO MILEAGE 1�
READING NATURE OF BUSINESS MILES
�Oo POINT POINT START FINISH TRAVELED PER MILE
0 L r
ro A k &I
yr, VI
U fJ L C
0 xt'
c cv lL
s gn 51 1t
rn L Ct W
naoQf L 0 r'
i 15 C. i c.�
CO G /1
IL4 ni o l J C1 Jy-L n-
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. I
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 part of the same has been paid.
Date r
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.
Simmonds, Valeska Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8111108 Reimb. Mileage 4/28/08 7/18/08 258.46
Total 258.46
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.
Simmonds, Valeska Allowed 20
In Sum of$
258.46
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 258.46 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
18 -Aug 2008
Signature
258.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I