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TO ALL ILECTION OFACERS <br />Gentlemen: <br />0 Your bill is to be made on the following form. <br />frl •�/�r= �rr � c1.� �.� �I� r� St- S��t�a,L � ��.� <br />CLAIM FOR ELECTION FEES <br />I certify that the undersigned were officers of an election held in Precinct No. <br />at <br />Name Position Amt. Due <br />?7536 <br />6,r►e. L M, f7 rt) mks, n d y[of 4LL o��� 2li',arkTvJudge $ .36-ate <br />co / a . -5 - 3 z o 7 /C c� � � � c rr � /� l a r e'7171 <br />� Asst. Judge $ 3 d • � <br />V rC leer Pare 7 7 YU-mclerk R 31�. <br />Clerk $ <br />t <br />$ <br />t <br />Delivering Returns $ _ <br />fi <br />Name of officer holding election— a ; i u r i P ►^ a M vri 0 -Y% <br />Mailing address T 61 e-o aeQ e Pk c r -Par y ry 77 15 �3 ,4 — <br />Sworn to and subscn'bed before me this _ day of Anrf L <br />y <br />°ems Designated Official <br />• <br />I <br />