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Home My WebLink About214078 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1 ` ONE CIVIC SQUARE VALESKA SIMMONDS CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $260.29 ANDERSON IN 46016 CHECK NUMBER: 214078 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 REIMB 215 . 89 TRAVEL FEES & EXPENSE 1082 4343000 REIMB 44 . 40 TRAVEL FEES & EXPENSE PRESCRIBED BY STATE BOARD OF ACCOUNTS �� GENERAL FORM NO.101(1986) ^` MILEAGE CLAIM TO d5 (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR iFICE,BOARD,DEPARTMENT OR INSTITUTION) FROM TO SPEEDOMETER DAT _ ` READING + AUTO MILEAGE POINT POINT START FINISH NATURE OF BUSINESS TAA MILES FLED @ r PER MILE W ac—r�rrn�lt c rr — [4 j - - ---- - _ 1 1 rdCL NP/nick m _.._ _ - s - c2> > - - ..----- -- AUTO LICENSE NO. TOTALS 55.5 + SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway map. ILI ( ZI 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 allow*n ust credits and that n art of the same has been paid. Date C0 Zts.IR -719— ioj8 i2 ell, � 7v _& 2012 21co.29 PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.10)(1986) MILEAGE CLAIM � t )Odes•I�, i m M on dS e2 TO V C,S (GOVERNMENTAL Ut71'C) ON ACCOUNT OF APPROPRIATION NQ. FOR (OFFICE,BOARD,DEPARTMENT OR INSTITUTION) DA FROM TO f SPEEDOMETER READING + AUTO tdI!EAGE MILES @ POINT POINT START FINISH NATURE OF BUSINESS TRAVELED 11 p�MILE C _z- - - ,5 b U.`cxj`�r - — 'rn.C.L Wc3oct — t PLC A L41 V3 t" _ ° --- `. rn --- - -o 0£ _ � A c_C EQ AUTO LICENSE NO. TOTALS (1 l SS,,5 + 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 legally dude,after aliowing all just credits and that//no part of the same has been paid. Date EID OCT 16 2012 PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO,IN(1986) `MILEAGE CLAoIM �i�sl<� c(Mm�r) (GOVERNMENTAL UNIT) I J ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE,BOARD,DEPARTMENT OR INSTITUTION) DATE SPEEDOMETER��E FROM TO I READING + AUTO MILEAGE ES 2� L= POINT j POINT START FINISH /NATURE OF BUSINESS TRAVELED PER MILE C -- ° -o —— m Cc _— --- - — - i _ IMc MUL �= S_ r4 _ C1-LA 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, - -5�' st'6\ 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 aliow.' all jus�credits,- and that no part o the same has been paid. Date �U • -j? �. T ° OCT 16 2012 i PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.10)(1985) MILEAGE CLAIM (GOVERNMENTAL-IR41T) TO.... 31[YVYWAJ� ON ACCOUNT OF APPROPRIATION NO.— FOR (OHICE,BOARD.DEP"THZNT OR INSTITUTION) SPEEDOMETER D FROM TO READING AUTO MMEkGE 1�7 i — + MATURE OF BUSINESS MILES POINT POINT START INISH TRAVELED PER MILE MCC, rp M raze Vrd>m/ Q46 I I q-11 f- MCC � q—13 CL 2) rh CL- -Tu 9-1; 0T- t RD f- )CC S 11 m(-L i r—O E 11 2 11 1 r,Of I V" 43L C-c- 3 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 1953,1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due,after a-liow—inq, all ju-s-t credits and that no part of the same has been paid. Date rz 4A, OCT�116 2012 BY:---,=::� PRESCRIBED BY STATE BOARD OF ACCOUNTS f GENERAL FORM 110.107(1986) MILEAGE CLAIM �,c V T l e5 (GOVERNMENTAL UNIT) a7/L. ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE,BOARD,DEPARTA¢NP OR INSTITUTION) DATE _ r SPEEDOMETER FROM TO tf — READING + AUTO MILEAGE ��--1t NATURE OF BUSINESS MILES @ t -i-i POINT POINT START FINISH 1'AAV-E PER MILE - V --gfo3y CL - - — M C-L VACL d A 4 ( -- YV1Lt- _ _ 15 11 l - S rVi cc U-t -d — trv►t� -_._ v- p £ _ 1 -- cc - -� -04L C,C+ -1 C" _ -- 0. AUTO LICENSE NO. TOTALS q/�y 151{ + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Scl-P �n 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 aR just credits and that no part ofG a same has been paid. Date �U ( t/L� (�kA.V0050 OCT 16 2012 C 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 10/9/12 Reimb Mileage 5/29 -7/3/12 $ 44.40 10/9/12 Reimb Mileage 7/9- 10/8/12 $ 215.89 Total $ 260.29 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 5-11-10-1.6 120 Clerk-Treasurer i Voucher No. Warrant No. 359285 Simmonds, Valeska Allowed 20 2703 E Lynn St Anderson, IN 46016 In Sum of$ $ 260.29 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1082-10 Reimb 4343000 $ 44.40 I hereby certify that the attached invoice(s), or 1081-4 Reimb 4343000 $ 215.89 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 18-Oct 2012. Signature $ 260.29 _ Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund