HomeMy WebLinkAbout170579 04/01/2009 a CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $135.85
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 170579
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343004 135.85 TRAVEL PER DIEMS
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Purchase P or
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GENERAL FORM NO. 101 1986
E CRIBED BY STATE BOARD OF ACCOUNTS
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P.o. f ILEAGE CLAIM
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(GOVERNMENTAL uNn) pate
Purchase ON ACCOUNT OF APPROPRIATION NO. FOR
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(OFFICE, BOARD, DEPARTMENT OR INSTITUT10hJ
SPEEDOMETER.
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES Q
POINT POINT START_ FINISH TRAVELED PER MILE
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AUTO LICENSE NO. y: 1 TOTALS
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SPEEDOMETER READING, columns are to be used only when distance between points cannot be determined by. fixed mileage or official highway map, TO I A L_ �4' f 3�f
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 part of the same has been paid.
Date
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
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I
(GOVERNMENTAL UNIT)
l ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE FROM TO
READIN G AUTO MILEAGE
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0 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED Q
PER MILE
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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.
Pur 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
.nd that no part of the same has been paid.
Date
ACCOUNTS PAYABLE VOUCHER
Jv� 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
1/31/09 Reimb. Mileage 1/5/09 2/28/09 FD 135.85
Total 135.85
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
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
In Sum of
135.85
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1046 Reimb. 4343004 135.85 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
25 -Mar 2009
Signature
135.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund