HomeMy WebLinkAbout204390 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $138.05
�y a ANDERSON iN 46016 CHECK NUMBER: 204390
CHECK DATE: 12/6/2011
DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION
1081 4343000 138.05 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS rsENF.RAL FORM NC. 10) {1986
MILEAGE CLAIM
TO l
(OOVnINMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPAAT}o! OR INStnInION)
SPEEDOMETER
DATE ROM TO y E READING AUTO tdILEAGE
POINT POINT START FINISH NATURE OF BUSINESS T'%ES' a
D
PER MILE
l
rn
to
AW
c.
CL
CL
MGCr
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. 15t(1 5
Pursuant to the provisions and penalties of Chapter 185, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all j t credits
end that no art of Ih same has been paid.
Dale I!r
0�
L y
fl NOV
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENE119L FORM NO 101 {1986]
MILEAGE CLAIM 4 Q I es �y lCA\ds
(GOVERNMENTAL UNIT( V
ON ACCOUNT OF APPROPRIkTEON NO. FOR
IOFaCP. BOARD, DEPARi1g57i oR imirrE nON)
FROM TO SPEEDOMETER AUTO I.(.ILEAGE
DATE READING M ILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED PER MILE
I
CL I
O-
WCL
rn (Y
i L
-t C.
Cc
t 0 b•
GC.
L i
yor
yy4c- I ns
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 ie just and correct, that the amount claimed is legal due, after aliowing all just c its
end that no p rt of the s e has been paid.
a
Date U Z 9 r n eq
I
Nov 2 z ?011
D n
PRE-SCRIBED $S STATE BOARD OF ACCOUNR OFXYRAL FOpy 11C. 101 {1"66)
MILEAGE CLA 1 C' 142 S V- 5m
(OOVFRNMDUAL UNIT} V
ON ACCOUNT OF APPROPRIATION NO. FOR
topacP, BOARD, DF ARTMIwT OR 1WMTnrr10N)
FROM TO SPEEDOMETER
DATE I READING
AUTO MILEAGE
Zo POINT POflVT STAA7 F3NFSA NATURE OF BUSINESS TRAV[LEA
PER MILE
I'L C 0
C
_t �C
-t C�
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-1 CG f.
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W1 cc_
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'YOf- �Y�C_
-2 C
L
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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. t
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 aliowing all jus credits
and thaj�A1 /p�rt ttyesame has been paid.
Date
NOV 2 2 2011 l i t
o
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
11/18/11 Reimb Mileage 9/12 11/16/11 138.05
I
Total 138.05
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
20_
Clerk- Treasurer
i
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of
138.05
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #lTITL AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 138.05 l 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
1 -Dec 2011
Signature
138.05 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund