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. ...JV.IVa.0 V� V.u.V uVu.V VI I'IVVVu.1.J <br />• Governmental Unit <br />4.r.. . V.... I.V. VJ. �. r.• LV V.//'.� <br />To.................................................................................... Dr. <br />IDEM South Bend Tribune <br />225 West Colfax Ave <br />............................................County, Indiana South Bend, Indiana 46628 <br />Tax ID# 35-13-1571 <br />PUBLISHER'S CLAIM <br />LINE COUNT Ad #: 8073 <br />Display Master (Must not exceed two actual lines, neither of which shall total more than four solid lines of type <br />in which the body of the advertisement is set) -- number of equivalent ................................... <br />Head --Number of lines ................................... <br />Body -- Number of lines ................................... <br />Body -- Number of lines ................................... <br />Total number of lines in notice <br />16 <br />COMPUTATION OF CHARGES <br />16 lines, 1 columns wide equals f6.gquivalent lines at 0.3555, -cents per line <br />• Additional charges for notices containing rule or tabular work . .... <br />(50 per cent of above amount) ................................... <br />Charge for extra proofs of publication <br />($1.00 for each proof in excess of two) <br />TOTAL AMOUNT OF CLAIM $5.69 <br />DATA FOR COMPUTING COST - <br />Width of single column in picas 9.4ems Size of 8. point, <br />Number of Insertions 1 <br />Pursuant to the provisions and penalties of IC 5-11=10-1; 1 hereby certify that the foregoing account is just <br />and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has <br />been paid. <br />I 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 1 time(s). The dates of publication being as follows: South Bend Tribune: <br />12/14/15. <br />South Bend Tribune <br />225 W. Colfax Ave. South Bend, IN 46628_ <br />ON ACCT OF APPROPRIATION FOR <br />$5.69 <br />Appropriation No. Tax ID# 35-138-1571 <br />ALLOWED <br />IN THE SUM OF $5.69 <br />Attest <br />Cheryl leloA�r�ey,otary Public <br />Resident of St. Joseph County <br />My Commission expires December 21, 2016 <br />That it is duly authenticated as required by law. <br />That it is based upon statutory authority. <br />correct <br />That it apparently c. <br />-incorrect <br />I certify that the within claim is true and correct; that <br />the services there in itemized and for which charge is <br />made were ordered by me and were necessary to the <br />public business <br />0 <br />