208043 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $124.32
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 208043
CHECK DATE: 4/1012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 124.32 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS
Sol GENT.p AL FORK IIC. 101 (1986)
MILEAGE CL Val -e SIUA /)S vl
(GOVERNMENTAL UNrq ON ACCOUNT OF APPROPRIATION NO. FOR
(OHICE, BOARD. DEPAATMEWT OR iNSr TLTr1ON)
DAT FROM TO I S READ R .yam AUTO 7 P ONT PONT START FINISH NATURE OF BUSINESS TRAVELED ILE
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V A AUTO LICENSE NO. TOTALS /7��uu SPEEDOMETER READING columns are to be used onl} when distance between points cannot be determined by fixed mileage or official highway mapfO�� 12
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the ainount claimed is legally due, after aliowing all just credits
and that no part of� the same has been paid.
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Date
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MAR 2 7 2012
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PRISCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 14C. 101 (19861
MILEAGE CLAIM
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO.. FOR
(OF BOARD, DEPAATWWr OR 1NST[rUrION)
l3PED
DATE FROM To READING ING AUTO MILEAGE
^r NATURE OF BUSINESS MILES Cd
POINT POINT START FINISH TRAVELED Pea
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AUTO LICENSE NO, TOTALS 1 LtZ t 5
SPEEDOMETER READING columns are to be used Only when distance between points cannot be determined by fixed mileage or official highway map. V iD
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 j credits
and that no part of the same has been paid.
Date �(a(� t��'1 2 'ot
q
I MAR 2 7 2012
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
or note attached in PO Amount
Date Number voice(s) or bill(s)) 124.32
3/21/12 Reimb Mileage 2/13 3/21/12
Total 124.32
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
1
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of
124.32
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 124.32 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
5 -Apr 2012
Signature
124.32 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund