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n <br />`,r Prescribed by State Board of Accounts General Form No. 99P (Rev. 2009) <br />(Governmental Unit) - To , - - - - - . Dr. <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 #0020198336 <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 />Body — Number of lines <br />Body — Number of lines <br />........................ <br />Total number of lines in notice 15 <br />COMPUTATION OF CHARGES <br />15 lines, 1 columns wide equals 15.00 equivalent lines at # cents per line $5.69 <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 />TOTAL AMOUNT OF CLAIM $5.69 <br />DATA FOR COMPUTING COST - - <br />Width of single column in picas 9.4ems ""Size of 7.5 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 # time(s). The dates of publication being as follows: March 09, 2015 <br />Z <br />Title: President & Publisher <br />South Bend Tribune <br />225 W. Colfax Ave, South Bend, IN 46628 <br />$5.69 <br />ON ACCOUNT OF APPROPRIATION FOR <br />W� <br />eryl June Morey, Notary 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 />Appropriation No. Tax ID# 35-138-1571 That it is apparently <br />incorrect <br />ALLOWED = � , . :. -. . <br />IN THE SUM OF $5.69 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 :a. ' } •.> <br />,. . Attest <br />