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Inv. # 081685-1
Form Prescribed by State Board of Accounts General Form No. 99 P (Rev. 1967)
Cilt Clem,—C�.t of I2�.C�,mo nC S.. .P Dr.
1 Palladium Publishin Cor .oration..
.................................................................................... To .._...._.......
(Governmental Unit)
1175 North A Street
....... ................... :......................... County, Indiana ............ Richmond, Indiana 47374
_..__........................................................
PUBLISHER'S CLAIM
LINE COUNT
Display Matter (Must not exceed two actual lines, neither of which shall total more
than four solid lines of the type in which the body of the advertisement is set)
number of equivalent lines
3
Head — number of lines ....""""""""""
� a
Body — number of lines .............
...........
3
Tail — number of lines ..................
• • • • • •
126
Total number of lines in notice ......................
COMPUTATION OF CHARGES 42 G'e 126
................... lines, ................... columns wide equals ................... equivalent
lines at ...., . cents per line
Additional charge for notices containing rule or tabular work """"""""""""
(50 per cent of above amount) 18.15
........... I............
Charge for extra proofs of publication
(50 cents for each proof in excess of two) .................. • • • • • •
54.44
TOTAL AMOUNT OF CLAIM $.........---.......
DATA FOR COMPUTING COST
Width of single column 9ems
Number of insertions ....Z.
Size of type 6 point
Size of quad upon which type is cast
Pursuant to the procisions and penalties of Ch. 155, Acts 1953,
I hereby certify that the foregoing account is just and correct, that the amount is lega4d,allowin Il jus s, and that no part
of the same has been paid.
Date: .............. I ...... 19 �'r'. Title.......Cashier..............................................__.._.......
VIT
ublic in and for said county and state,
ho, being duly sworn, says that he is ..CSl=ier
,f general circulation printed and published in the
Indiana in state and county aforesaid, and that the
copy, which was duly published in said paper
beingas follows: ...........................................
15
..............................................................
.............. .. ......
Z"i6h
i"iIugust 35
. day of ......................... 19 ...........ry........................... Public
January li, 1906
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