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Prescribed by State Board of Accounts General Form No. 99P (Rev. 2009) <br />_ r <br />(Governmental Unit) ToDr. <br />IDEM South Bend Tribune <br />County, Indiana 225 West Colfax Ave <br />---------------------------------- South Bend, Indiana 46628 <br />Tax ID# 35-138 1571 <br />PUBLISHER'S CLAIM <br />LINE COUNT Ad #0020143801 <br />Display Master (Must not exceed two actual lines, neither of which shall total more than four solid lines of the type in <br />which the body of the advertisement is set) — number of equivalent .............. . . ... . ......... . . <br />Head — Number of lines <br />............................... <br />Body — Number of lines <br />Body — Number of lines <br />........................ <br />Total number of lines in notice 16 <br />COMPUTATION OF CHARGES <br />16 lines, 1 columns wide equals 16.00 equivalent lines at # cents per line $5.90 <br />Additional charges for notices containing rule or tabular work <br />(50 per cent of above amount) <br />..... .............. ......... <br />Charge for extra profs of publication <br />($1.00 for each proof in excess of two) <br />....................... <br />TOTAL AMOUNT OF CLAIM $5.90 <br />DATA FOR COMPUTING COST <br />Width of single column in picas 9.4ems Size of 7.5 point. <br />Number of insertions <br />Pursuant to the provisions and penalties of IC 5-11-10-1, I hereby certify tTiat the foregoing account is just <br />and correct, that -the, amount, clairoed is legally due, after allowing all just credits, and that no part of the same has <br />`been paid. <br />also certify that the printed matter attached hereto is a true copy, of the same column width and type size,, , <br />which was duly published in said paper # time (s). The dates of publication being as follows: November 10, 2014 <br />t' <br />0J—L4A — . <br />Title: President & PublisherF Che I June More Nota Publi <br />_ rY Y� Notary <br />Resident of St,=Joseph County <br />My Commission expires December 21, 2016 <br />South Bend Tribune <br />225 W. Colfax Ave, South Bend, IN 46628 That it is duly authenticated as required by law. <br />$5.90 That it is based upon statutory authority. <br />ON ACCOUNT OF APPROPRIATION FOR <br />correct <br />Appropriation No. Tax ID# 35-138-1571 <br />ALLOWED <br />IN THE SUM OF $5.90.,„ v <br />Attest <br />That it is apparently <br />incorrect <br />I certify that the within claim is true and correct; that the services <br />there in itemized and for which charge is made were ordered by me <br />and were necessary to the public business <br />