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Prescribed by State Board of Accounts General Form No, 99P (Rev. 2009A) <br />Governmental Unit <br />THIENEMAN CONSTRUCTION, ING South Bend Tribune <br />635 S. Lafayette Blvd., Suite 138 <br />Indiana South Bend, Indiana 46601 <br />Tax ID# 83-2810977 <br />PUBLISHER'S CLAIM <br />LINE COUNT Ad # 878912 <br />Display Master (Must not exceed two actual lines, neither of which shall <br />total more than four solid lines of the type in which the body of the <br />advertisement is set) -- number of equivalent lines ........................... <br />Head -- number of lines ... <br />Body -- number of lines <br />Tail -- number of lines <br />Total number of lines in notice 26 <br />COMPUTATION OF CHARGES <br />26 lines, 1 column(s) wide equals 26 equivalent lines at 1.68 per line <br />Additional charges for notices containing rule or tabular work <br />(50 percent of above amount)a>> u <br />Charge for extra proofs of publication <br />($1.00 for each proof in excess of two) <br />TOTAL AMOUNT OF CLAIM $ 43.68 <br />DATA FOR COMPUTING COST <br />Width of single column in picas 9.4 ems Size of type 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 <br />just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same <br />has 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: 08129120. <br />Shelley Chal n <br />Vice Presiden of Advertising <br />Market Lead, South Bend, IN <br />574.235.6558 <br />South Bend Tribune <br />635 S. Lafayette Blvd., Suite 138 <br />South Bend, IN 46601 <br />ON ACCOUNT OF APPROPRIATION FOR <br />$ 43.68 <br />Appropriation No. Tax ID # 83-2810977 <br />ALLOWED <br />IN THE SUM OF $43.68 <br />est <br />CHERYL JUNE MOREY <br />Notary Public - Seal <br />St Joseph County - State of Indiana <br />Commission Number 693302 <br />Wy q�mrr�issir,rn Expires Dec 21, 2024 <br />Chr •yi ,tune Morey, t4otary r <br />Resident of St. Joseph County - Sta of Indiana <br />Commission Number: 693302 <br />My Commission expires December 21, 2024 <br />That it is duly authenticated as required by law. <br />That it is based upon statutory authority. <br />That it is apparently <br />correct <br />incorrect <br />I certify that the within claim is true and correct; that the serv- <br />ices there in itemized and for which charge is made were ordered <br />by me and were necessary to the public business. <br />