214078 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> > - -
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--
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
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b
U.`cxj`�r - — 'rn.C.L Wc3oct — t PLC
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-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,
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Q46 I I
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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