209843 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $144.58
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 209843
CHECK DATE: 6/1812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 144.58 TRAVEL FEES EXPENSE
PRISCBDWD BY STATB BOARD OF ACCOUNTS Gana L roa RO. 101 119M
MILEAGE CLAIM
TO
(GOVS21daRrAL UlaTt
ON ACCOUNT OF APPROPRIATION NO. FOR
(O"VZ BOARD. DWARTWINtr OR
DATE FROM TO REARDIIOVMGETER AUTO MILEAGE
20 POINT POINT START FINISH NATURE OF BUSINESS TRAY
PER MILE
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AUTO LICENSE NO. TOTALS 3
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 51
Pursuant to the provisions and penalties of Chapter 155, Acts 1893, I hereby certify that the foregoing account is just and correct, that the amount claimed isle ally due, aft�affiowin l j ust credits
end that part o�� same has been paid.
Date l -6
CETV
MAY 3 0 2
I et, P
PEC=M D BY BUTT EOMD OF ACCODin9 GBIEIAt POEM MO. l a 1198
MILEAGE CLAIM �m�S
TO
AL UNm
ON ACCOUNT OF APPROPRIATION NO. FOR
(0"=, 60ASD, CoArraw as
DATE FROM TO SPE OMETER
7) POINT POINT SfAR READING FINISH READING NATURE OF BUSINESS A UTO MII.BAGS
PER MM
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AUTO LICENSE NO. TOTALS O
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. L l 49 R5
Pursuant to the provisions and penalties of Chapter 155, Acts 1853, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowiag anust credits
end tha ar rtt of the ame has been paid.
Date J
8)e
MAY 3 0 2
1
BY.
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NC. 01 (1986)
MILEAGE CLAIM 3 1 0a
rn To ns
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFi1CP, BOARD, DEPARTMENT OR INST=108)
SPEEDOMETER
z Dq,TTti FROM TO READING AUTO MILE AGE
NATURE OF BUSINESS MILES (y
POINT POINT START FINISH TRAVELED 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.
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 leg ly du after aliowing all ju t credits
and thnt no pert of the same has been paid.
Dat
MAY 3 0 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
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/25/12 Reimb Mileage 3/22 5/25/12 144.58
Total 144.58
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
144.58
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 144.58 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
14 -Jun 2012
Signature
144.58 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund