HomeMy WebLinkAbout217817 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
0 ONE CIVIC SQUARE VALESKA SIMMONDS
� CARMEL INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $105.28
,
ANDERSON IN 46016 CHECK NUMBER: 217817
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 105 . 28 TRAVEL FEES & EXPENSE
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GENERAL FORM 110.101 11986)
PRESCRIBED BY STATE BOARD OF ACCOUNTS 4
MILEAGE CLAIM I J C(L c, S ,tmt, d
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�(OHICE, ENTAL UNIT) ACCOU T F APPROPRIATION NO. FOR
BOARD,DEfAATI[EM ON INSrRUItON)
SPEEDO ETFA AUTO WLEAGE f
TO READING + NATURE OF BUSINESS MILES a
DATE FROM TRAVELED
POINT POINT START FINISH i PER MILE
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TOTALS
AUTO LICENSE NO.
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fix Ed ileage or official highway map.
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Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing accc unt is jus ar d correct,that the amount claimed is legally due,after also g all just credits.
end that no part of the same has been paid.
Date l 1
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FEB 7 2013
BY:
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PRESCRIBED HT STATE BOARD OF ACCOUNTS
GENERAL FORM IIG.101(1986)
MILEAGE CL IM V\ 1
PC _
(GOVERNMENTAL UNIT)
S� ACCOU T F APPROPRIATION NO. FOR
(OF,-ICE,10E,BOARD.DEPARnA oil INST[TUTION)
SPEEDO ETER
DATE FROM TO I READI + AUTO MMEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
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AUTO LICENSE NO. TOTALS t 555
I+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determini d by fix d I hedge or official highway.map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing ace unt is jus ai Id cirrect,that the amount claimed isle lly due,after allow g all just credits
end that no part of the)sa a has been paid.
Date
j
FEB 7 2013
iBY:
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
1/24/13 Reimb: Mileage 12/4/12 - 1/29/13 $ 105.28
Total $ 105.28
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$
$ 105.28
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or
Dept# INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1081-4 Reimb 4343000 $ 105.28 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
21-Feb 2013
Signature
$ 105.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund