159603 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 232 S ARLINGTON AVENUE CHECK AMOUNT: $223.21
INDIANAPOLIS IN 46219 CHECK NUMBER: 159603
CHECK DATE: 5/1412008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343000 223.21 TRAVEL FEES EXPENSE
n
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM i d S
TO v l��G
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER.
AUTO SEAS E
MILES DATE READING
o POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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Ann C%
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AUTO LICENSE NO. TOTALS
i
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. �f'J
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 art of the same has been paid.
Date p b
'Ma,.
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1966)
MILEAGE CLAIPYI
To
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR A 2
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING NATURE OF BUSINESS MILES
o POINT POINT START FINISH TRAVELED PER MILE
J
MCI r-O C �P1�1
lc..(
L't E k
MCI Ow c
r
i tziCt,.--- C i
M C-
i
r
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le
AUTO LICENSE NO. TOTALS 0
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, a ter allowing all just credits,
znd that no part of the same has been paid.
Date
PRESCRIBED BY STATE BOARD OF ACCOUNTS RAL F_ NO. 101 (1896)
MILEAGE CLAI ,,��1
TO— Il/1 r i L►� (r
f
(GOVERNMENTAL uNrr) ON ACCOUNT OF APPROPRIATION NO. FOR tBy
I
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES e
.w POINT POINT START FINISH TRAVELED pER MILE
U
L fig.
h
su'c i
rt 4, f r)
L
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111
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V
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b L c M 5
v�
on
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G= w xM
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 reap.
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, afte allowing all just credits
end that no part of the same has been paid.
Date
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO- 101 (1966)
MILEAGE CLAIM C' *'r777\7D
Tam �j 7 008 (}p
(GOVERNMENTALUNTT, APR
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
FAY:
SPEE
DATE FROM TO kREADING R AUTO MILEAGE
NATURE OF BUSINESS MILES POINT POINT FINISH TRAVELED PER MILE
V Y)/N C f 1= &T i
A
r C �c r Q
Q
t%
l t0 `f u
Ce C
31 14 eALL b Sty RPI E
Lk 0 ry
3 17
7
i
r J Ybl
1
3 0
G
C M C_ a I i il
3 L 4
0 �Z
f W t 'f_ N CCkr
L) AUTO LICENSE NO. TOTALS
a
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 just credits,
a.nd that no part of the same has been paid.
Date i
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
(GOVERNMENTAL' UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR r
(OFFICE, BOARD, DEPAATMENT OR INSTMTION) JJ L1 L15�
DATE FROM TO READING
AUTO MILEAGE
NATURE OF BUSINESS MILES Q
it IQ POINT POINT START FINISH TRAVELED PER MILE
d e/' C (:i-
A n D
DCkO C--
a,
err Tr.e 4E o�
rte [i
441 T,4 e
F
y -iL4 aRes i.
C;, C._ t
c 5
ile'Just Q-r lea 61
r
C— L
i G�-� t
AUTO LICENSE NO. TOTALS
5(9
SPEEDOMETER READING columns are to be used only when distance between- points cannot be determined by. fixed mileage or official highway map. 7}7�`f P
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 d" e, after allowing all dits
end that no part of the same 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.
Valeska Simmonds
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4118108 Reimb. Mileage Reimbursement 223.21
Total 223.21
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.
Allowed 20
Valeska Simmonds
In Sum of
223.21
I
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #rrITLE AMOUNT Board Members
Dept
1046 Reimb. 4343000 223.21 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
12-May 2008
Sign to
223.21 Business Se s Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I