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TO ALL ELE <br /> <br /> <br />• Gentlemen: <br />Your bill is to be made on the following form. <br />~c,i~~;r~i.=7) l'iiYi~wr~ S`".,~~,~/~ t~Sir~Ili /_~c~T'ic~~/ _ <br />CLAIM FOR ELECTION FEES <br /> <br />v <br />• <br />• <br />I certify that the undersigned were officers of an election held in Precinct No.~~ '~'~-L ~ <br />at ~ O ~- L e n ~_ ~_!~~!-e m <br />Name (,/ //J/ ~~ J Position Amt. Due <br />~ ~.G~J <br />Judge $ ,3 ~' ~ D <br />.Judge $ ~ ~' ~~ ~ <br />' ~ I `~.J <br />Clerk g <br /> Clerk $ <br /> $ <br /> <br /> $ <br /> <br />__ $ <br /> <br />Delivering Returns ~ <br />$ -- <br /> <br /> T(~TAT, ~ ~d ' ~ <br />Name of officer <br />Mailing address <br />7 <br />Sworn to and subscribed before me this ~ day of ~- 4-~h-~~ 19 ~ l <br />Designated Official <br />°°3 <br /> <br /> <br /> <br />