226153 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
,. o CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $260.64
o�"do ANDERSON IN 46016 CHECK NUMBER: 226153
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 149 . 90 TRAVEL FEES & EXPENSE
1082 4343000 REIMB 110 . 74 TRAVEL FEES & EXPENSE
PPlSCRIBED BY STATE BOARD OF ACCOUNTS
KR AL FORM NC.107(1906)
� ��� MILEAGE CLAIM E I,��mow" ,
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF71CP,HOARD,DEPARTMENT an INSnTUr10N)
DATE FROM — TO SP EEDOMETER
_ READING + AUTO MILEAGE
NATURE OF BUSINESS MILES C4r z
POINT POINT START FINISH TAAVELED PERK
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. . �j 4
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 allowing all just cr its V VIA)
and that no part of the same has been paid.
Date
0 � NOV
-5 201
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORW IIO.101(1924)
MILEAGE CLT IM
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(� (GOVEANMENTAL UNIT) ACCOU T F APPROPRIATION NO. FOR
(OfAeP,BOA AD,DEPAAT1lrNr OA]NSr(TUIION)
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T FROM TO READl
2bD1 POINT START FINI3H NATURE OF BU F RAVELED PER MILE f
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AUTO LICENSE NO. TOTALS $"'1 C
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determin d by fix d ileage or official highway map. I�1'�J
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing acci unl is ju a d correct, that the amount claimed is legally due,after allowing all just redits r
and that brio part of the Same has been paid.
Date )U - 1-7
of� NO
,I, 5 2013
i
PRESCRIBED BY STATE BOARD OF ACCOUNTS GERMIL FOAM 110.101 t19eb)
MILEAGE CLAIM d�lh
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(OOVEIINMENTAL 51T)
ACCOU T F APPROPRIATION NO. FOR
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(OMCE,HOARD.DEPARTUM(T OR INSrMJTION)
SPEEDO ETER
DATE FROM TO I-- AEADI 4- I I AUTO NILEAG£
r� NATURE OF BUSINES6 MILES Q
POINT POINT START FINISH TRAVELED PER MILE
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be delermin d by fix d ilea or oflicial highway.map-
Pursuant to the provisions and penalties of Chapter 155,Acts 1853,I hereby certify that the foregoing acc unt is ju a d correct,that the amount claimed is legally due,after allowing all sl credits
end that no art of the same has been paid.
—AADate
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PALSCAIBED BY STATE BOARD OF ACCT.!STS I GENERAL FOAU 110.IBI 11-0
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SPEEDO ETER AUTO MILEAGE
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determin d by fix d Ileage or official highway map. 53,11
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Pursuant to the provisions and penalties of Chapter 155,Acts 1853,I hereby cartily that the foregoing acc unt is ju. a d correct,that the amount claimed isle ly e,after allowing all ju credits
and that r part of the same has been paid.
Date
-t
! NOV �'�
of�- + I 2013
1
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PRLBCRIBCb BY STATE BOARD OF ACCOUNTS �
GENTAALiOP11 RC.101(190[7
MILEAGE CL IM �
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(GOVEANNENTAL UNIII I. ACCOU T F APPROPRIATION NO, FOR
Y (0/7CQ,BOABL,DEPARTMENT OR INsrrnmoN)
FROM TO SPEEDO ETEII AUTO MILEAGE
READI A
ZOD POINT POINT START FINISH NATURE OF BUSINESS TRAVELED ® PER MILE 4
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AUTO LICENSE NO. TOTALS Z i
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be delermin d by fix d ileage or official highway map. .W
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing aco unt is ju, a d correct, that the amount claimed is leg 1 ue ter allowing all just cre is
and that no pars of the same s been paid.
Date ld 2-A
/° ---
,� Jam` s
d
j �OV - M3
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
11/5/13 Reimb Mileage 5/29- 8/14/13 $ 110.74
11/5/13 Reimb Mileage 8/15 - 11/5/13 $ 149.90
Total $ 260.64
I 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$
$ 260.64
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
Po#or Board Members
Dept#
INVOICE NO. ACCT#/TITLE AMOUNT
1082-10 Reimb 4343000 $ 110.74 1 hereby certify that the attached invoice(s), or
1081-4 Reimb 4343000 $ 149.90 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-Nov 2013
Signature
$ 260.64 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund