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Revised City Claim Form No. 201 <br />Form Prescribed by the State Board of Accounts. <br />A claim, to be properly itemized, must show: Kind of service, where performed, dates service rendered, by whom, rate per day, <br />number of hours, rate . per hour, price per foot, per yard, per hundred, per pound, per ton, etc., and accompanied with the blue copy <br />of requisition. <br />Cagy ®f South Bend, Indiana �a The South Bend Tribune Dr. <br />On Account of Appropriation <br />Street 225 VV. Colfax Ave <br />Requisition Flo. Address <br />19 70 <br />ITEMIZED CLAIM <br />Legal Advertising— Notice of <br />Ordinance NO <br />2 publications— Sept 4 and Sept 1191970 <br />50 Lanes (.288 per line) <br />DOLLARS CTS. <br />Total I 14 <br />I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after al- <br />lowing all just credits, and that no part of same has been paid. <br />Date <br />Septeriber 1191970 Title Credit Manager <br />This certification is in compliance with new Indiana Law;Chap. 155 -SB 288; effective July 1, 1953. <br />4D <br />M <br />c�9 Q <br />w G, <br />O of <br />O <br />cr) W) <br />q I I I <br />I <br />E •b ti I I I <br />� A tl • � I I I y <br />q 0, <br />C• .q <br />A I I I I <br />• j <br />a « •i d M � I 'OI �, O , <br />.F 0 w q J7 Pn q <br />0` I I I I <br />r I ° O p Rt b G4 <br />m %� <br />.+ I . J lV b N, o <br />Q Po ° •G %> I 4 ° q m I d I .4 <br />IA v p 6 1 a 7 <br />d nom'+ > 6 I ° ED q ; ° I •iM .I <br />a m .d m• <br />m <br />I :-• d I I o <br />�y p 3 'O m 1 �>1 <br />Cn /G V <br />0 4Qg R=g2 c. ° ?O <br />IOC LV �NOO _LZ�j _L OY _ >�L eLL OR_iJ <br />°O °v LPm. C'c £N Ox ^v°,Ea °c <br />j; nJ > =.o ENO%U ^i0 OV�uc3xz °oa cQ °��t Qu.y.4.vG °� �aL` <br />J O'oV0 ••�- 00$u6d `= QEO9 cUW CQOOU Oo.Y <br />OC ..8 OJV Q�y OL <br />E co `�xo� 2_x„gex <br />a c_"e�L cu oucdc_ <br />OL fc u ^yE-VOmL COOL• -� ON 0000 �0 CO` t�0' OOVrrM �uoUCp <br />W >••' !�9'ii� C 09 O 9J� VOO �QOO ��i0 <br />U_ °c VOC`moo S o° VoN vat °.. -. O^ OF 3 <br />D Oc$t °no <br />O L.—U, ui <br />�� —< d'c "o oouo W9Y a�NFo3 ao ao_ ^o� aa�o� '`t <br />ZooNbii OC6L >CLLL .L. y1V0 �VLL - <br />