HomeMy WebLinkAbout220785 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $377.59
�4�?a CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 220785
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 377 . 59 TRAVEL FEES & EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM H0.101(1986)
MILEAGE CLAIM
U TO-� k. , �'
(GOVERNMENTAL ON ACCOUNT OF APPROPRIATION NO,— FOR
FROM TO SPEEDOMETER AUTO MILEAGE
_wUiytZ READING + NATURE OF BUSINESS MILES @ C
POINT
POINT START FINISH TRAVELED
PER MILE
0
MCC-
F.D;—r rA 4E-
FOE'
E)
rACC.
I R-1
T-� rA U-
MC4- FO S --- ----
Kng5iv I Ime-C.
R0 1'�
r-101
!L ct 1 -3 11
FD
to
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 allowing all i t credits
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and that no art of the same has been paid. �w allowing I
Date
MAY 2 116 220133
BY;
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 140.10,(1986)
MILEAGE CLAIM
�e? TOA
(GIOVERKNENT UNIT) ON ACCOUNT OF APPROPRIATION NO, FOR
(OFFICE,HOAR➢,DEPARTMENT OA tNSTTFVLiON)
—----- .........T SPEEDOMETER AUTO MILEAGE
D T FROM To READING + MATURE OF BUSINESS TRAVELED
TRAVELED
POINT POINT START FINISH PER W
t --------
CL
Po C -4
two
Fob Z-C-
ry
C-C-
2-Q
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,'l hereby certify that the foregoing account is just and correct,that the amount claimed is le ally due,after allowing all just credits
end that4o Pali of t�o 4 me as been paid.
Date T' a 2 -300
MAY 21 2013
i
' f
PRESCRIBED BY STATE BOARD OF ACCOUNTS �� , GENFA L FORD NO.181[19867
MILEAGE CL IM L /� /A� (�
i T � (� �A' d�� `C�'l�.J
CA� Z
L (60VERNNEHTAL 1117IT)
ACCOU 4T F APPROPRIATION NO, FOR
OHICE,BOARD,DEPARTTQ(T OR 1NSrMJTION)
SPEEDO ETER
DATE FROM TO READI + AUTO MILEAGE
NATURE OF BUSINESS MILES I& c
2-� POINT POINT START FINISH TRAVELED PER MILE
O
I
-a VAU
+G '
l _
ro
wt CL rc ar I L4.5
<r. M0 f-- I
b
AUTO LICENSE NO.
TOTALS r y� S
_ [�
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determini d by fix d mileage or official highway map. 39�✓/�
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is ju aid correct,that the amount claimed is leg fly d e,after allowing all j credits
and that ^part of the same as been paid.
Date i
1 ; MAY 21 2013
f3�':--
i
PALHCflIHLD BY STATE HOARD OF ACCOUNTS
UNFAAL FOR11 NO 101(1926)
MILEAGE CL IM
(OVFANNEN7A1 UNIT)
ACCOU T F APPROPRIATION NO. FOR
(OFFICE,HOARD.DEPARTUENr OR INSTITUTION)
SPEEDO STER
D� FROM TO READI .(- AUTO MILEAGE
Zb
NATURE OF BUSINESS MILES a s
POINT POINT START FINISH TRAVELED
PER MILE
MCC_ OrM
L ✓ c
cc-
�0 - - -- j
NAh
� c c
S- co
IN L
p -- CL
AUTO LICENSE NO, TOTALS 1STDJ
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be dkermLne d by fixed ileage or official highway map.
i
Pursuant to the provisions a3Id penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing acc unt is ju a d correct,Lhat the amount claimed is ga due,after allow- all just credits..
end that AQ part of the has been paid. j
Date
J^�o
`yam
MAY 2 1 2013 l
i
I
i
fI
I
I
PRLSCRIBED BY STATE BOARD OF ACCOUNTS ^ GENERAL FORW 110.101(1986)
MILEAGE CL TM � C
r
(OOVEANNENTAL IMITI I
N ACCOU T F APPROPRIATION NO. FOR
I
(OFi10E,BOARD,DE?ABrNEI{r OA MiBT UI15
SPEEDO ETER
t�' FROM TO AEADI AUTO MILEAGE
z6DA1-� P01NT pOMT START F NISH I(
NATURE OF BUSINESS TRAVLELED f
PER MILE
rvi 5c-
S-tN E MCC --
-r
-� -o f rn CC-
-� —
tto rr.
S- �-
r
— i
I
AUTO LICENSE NO. TOTAL9 �o'
_ V
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determin d by fix d I Aleage or aflicial highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing ace unt is jus ai d correct,that the amount claimed is legally due,after aliowing all just credits
and that no pa o1 the s;me has paid.
Date
1
1r,N"L
MAY
2 1 2013
Carmel e Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
1-1 2 C k rd M4u I r 'd$1- ;Wo Fee- i . Z ✓ o`r�-��,� �r
v V QA
L. v-'
! (Z CCt lU-�tl- 3413 oco �-an i g- 7 r��►u
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: ZCi $0.00
Employee Name(print) k)aj�kCA
_ 21 2013 t
Address -7O l -. L}tn n S� r-e+
Check LMAY
payable to: City, St, Zip def"- 9(oa tG
Signature: V11k Approved by:
Date: � Z Date:; �" 4-
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
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
5/21/13 Reimb Mileage 2/1 - 5/21/13 $ 342.39
5/20/13 Reimb Expenses for National Convention $ 35.20
Total $ 377.59
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
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of$
$ 377.59
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO ACCT#/TITLE AMOUNT
1081-4 Reimb 4343000 $ 342.39 I hereby certify that the attached invoice(s), or
1081-99 Reimb 4343000 $ 35.20 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
30-May 2013
Signature
$ 377.59 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund