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Form Prescribed by State Board of Accounts General Form No. 99P (Rev. 2002) <br />To: SBN South Bend Tribune <br />(Government Unit) <br />_________ County, Indiana _____ _ <br />Acct#: 551382 <br />Ad#: 11606552 <br />DAT A FOR COMPUTING COST <br />Width of single column 1.53 in <br />Number of insertions <br />Size of type 7 point <br />130 lines, 1.0000 columns wide which equals 130 equivalent <br />lines at $0.52 per line @ l days <br />Website Publication <br />Charge for proof(s) of publication <br />TOT AL AMOUNT OF CLAIM <br />Claim No. _____ WarrantNo. ___ _ I have examined the within claim <br />and hereby certify as follows: IN FAVOR OF <br />South Bend Tribune That it is in proper form. <br />$67.60 <br />$0.00 <br />$0.00 <br />$67.60 <br />635 S Lafayette Blvd, Ste 138 <br />South Bend, IN 46601 <br />That it is duly authenticated as required by law. <br />That is is based upon statutory authority. <br />That it is apparently ( conect) <br />$ __________ _ <br />On Account of Appropriation For <br />FED JD <br />83-2810977 <br />Allowed _________ , 20 ___ _ <br />In the sum of$ ____________ _ <br />I ce1iify that the within claim is true and correct, that the services there-in <br />itemized and for which charge is made were ordered by me and were <br />necessary to the public business. <br />(in correct) <br />Page 2 of 3