206810 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
p ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $142.49
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 2,06810
CHECK DATE: 212812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 142.49 'TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS �al�s�� S(DMQIJ5
GENERAL FOR11 NO. 101 11786]
MILEAGE CLAIM
(GOVONNENrAL UN1I]
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFeICE, BOARD, DEEAAT1UWE OR INSr=108)
SPLEDOMETFR AUTO l4ILEAGE
DATE FROM To I READING NATURE OF BUSINESS MILES (Q
2 POINT POINT START FINISH TRAVELED PER WU
_l.
Q
1-
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r
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f 1
AUTO L TOTALS
ICENSE NO.
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 t e loregoing account is just and correct, that the amount claimed is legal] ue, after aliow' all just credits r
and th t 8q of the s Is has been paid.
Date I
0 T3
an
FEB 1 3 1011 OV
��a
PRESCRIBED BY sTATr BOARD Oi ACCOUNTS GERF.RAL rOAY 11C_ 101 (19667
MILEAGE CLA
OQ La- U M y /t S
(GOVERNMENTAL U11I17
ON ACCOUNT OF APPROPRIATION NO- FOR
tOFME, BOARD, DEF"TY1FKr OR IN rMMOX)
SPEEDOMETER
DATE FROM To READING AUTO MMEAGE
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELED PER MILE
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M
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AUTO LICENSE NO- TOTALS 1 t 5 t t
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway. map. 4 4—
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
and that no part of the same has been paid.
Date L
4
PRESCRIBED 8T STATE BOARD OF ACCOUNTS 1 CERT.RAL FORM NG. ICI {19867
MILEAGE CLAIM
Tp I St
yyy
(GOVERRUENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
COMM SOARS, DE "tF6'XT OA INSrM- rr10N)
SPEEDOMETER
AUT t1tLF
IxG
DA FROM TO TE i READING O NATURE OF BU
SINES Q, S ttILES
POINT PODVT START FINISH TRAVELED PER 14LE
GC c: sit M
MLZ
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MCC
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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�F'ti LIJ
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
and that no art of the same has been paid. 11 It
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
2703 E Lynn St Date Due
Anderson, IN 46016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
2/6/12 Reimb Mileage 11/16/11 2/6/12 142.49
Total 142.49
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$
142.49
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 142.49 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
23 -Feb 2012
Signature
142.49 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund