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HomeMy WebLinkAboutPublic Notice80000-5454094 PUBLISHER'S AFFIDAVIT State oC Indiana SS'. ' NOTICE GF PUBLIC ~ - MARION COUDIy HEARING BEFORE THE ~ + CARMEL/CLAV ADVISORY . I BOARD OF ZONING -1 APPEALS I Personally appeared before me, a notary public in and for said county and state, . DOOket Nn. 89040804V~ ~ Notice Is hereby'g rven I of Z A o alsl B t e says that SHE is clerk duly sworn Dodson who bein rr th d i d K oni im9 p Oa rtl , , g y e un ers gne e of the INDIANAPOLIS NF WSPAPERS a DAILY STAR newspaper of general circulation printed and published in the English language in the city of INDIANAPOLIS in state and county aforesaid, and that the printed matter attached hereto is a true copy, which was duly published in said paper for 1 time(s), behveen the dates of: 04/23/2009 and 04/23/2009 G''~ ~~~t9~'1N~=S~ - Clerk \ 'J\ Title Subscribed and sworn to before me on Form 65-REV I-RR 'tionetltime and Place. ` MycommlSSion .PETITIONER: (Clay & Allyaon Milenaer d.. (B'- 4/23/09_5454W4) STATE PRESCRIBED FORMULA 7.83 PICA COLUMN - 94 POINT 94 POINTS / 5.7 PT. TYPE - 16 49 16.49 EMS / 250 - .06596 SQUARES .06596 SQUARES x $5.14 - .339 CENTS PER LINE NOTARY PU9LIC SEAL STATE QF INDIANA RATE PER LINE PUBLISHED lTIME= .339 PUBLISHED 2 TIMES= .509 PUBLISHED 3 TIMES= .679 PUBLISHED 4 TIMES= .848 n Board of Zonine Appeals Public Notice Sien Procedure: ~ RECEIVED a g~Y _ 8 ~ The petitioner shall incur the cost of the purchasing, placing, and removing the si .The si must be placed in a highly visible and legible location from the road on the prope at is ~QCS involved with the public hearing. ~ ~b The public notice sign shall meet the following requirements: iy `F 1. Must be placed on the subject property no less than 25 days prior to the public d Zl L 4 ~ hearing 2. The sign must follow the sign design requirements: Sign must be 24" x 36" -vertical Sign must be doubte sided Sign must be composed of weather resistant material, such as corrugated plastic or laminated poster board The sign must be mounted in a heavy-duty metal frame 3. The sign must contain the following: • 12" x 24" PMS 1805 Red box with white text at the top. • White background with black text below. • Text used in example to the right, with Application type, Date*, and Time of subject public hearing * The Date should be written in day, month, and date format. Example: .,,~~., 1 1 Cannel City Hall iii.., „~~ For More Infonnatian: p, c~) ~a~w~c.carmcl.in.gov IPIU ~~I-~~I7 Monday, January 23 4. The sign must be removed within 72 hours of the Public Hearing conclusion ti,~~~ ..~M`"~ Public Notice Sien Placement Affidavit: I (We) Glcy ~~ ~; AilYsd„ l'61'~Q„ag~ do hereby certify that placements of the notice public hearing to consider Docket Number ,was placed on the subject property at least twenty-five (25) days prior to the date of the public hearing at the address listed below. . ,.,, . ;~ ~ i STATE OF INDIANA, COUNTY OF , SS: = - i~ r-~~ , ~~ ~! The undersigned, having bee duly sworn, upon oath says that the a information is tme and ~-_-_, -~ correct as he is informed and believes. ~~ =-J'--~ ,- _~ - ,,, ~ ~.• (Si re of etitioner) "''f~° ^"~~ Subscribed and sworn to before me this~day of ~ J Notary Pub is My Commission Expires: z 6 iO SEAL ~ lINOA S. MO53, NO7AgY PUBLIC -~ SiA7E OF INDIAN0. BDDNE COONTY . .,~, ,~, MY COMMISSION E%PIgE3; 01.23-2017 ~ Complete items 1, 2, and 3.AIso complete item 4'IfRestricted Delivery Is desired. Print your name and address on the reverse so that we can return the card to you. t Attach this card to the back of the mailpiece, or on the front iF space permts. . Article Addressed to: A B.'Recelved by ^ Agent ^ Addressee Date of DelNery D. Ls deIrvery address different from Nem 17 U Yes It YES, enter delivery address bebw: ^ No ~/. .~ ~:. ~, '~ . 3. Service~Type Qv '4i ^ Certllf9A;Mafl' ^ Eta Melt ^ Regtste~retl~_~~{tetum Fiecelpt for Merchandise l7 Insures Mall ~© C.b.D. 4. Reslrh*ed Delivery! (Ezha Fee) ^ Yes !. Artlda Number _ _ -_.. ___ _____. R'~'h°"'~Ce~ ?0~8 1830 0002 _5860 0353 'S form 3811, February 2004 ~ - -~ llomestic Return Receipt 102595-02-M-7540 ~ Complete items 1, 2, and 3. Also complete A ture - kem 4 if Restricted Delivery is desired. X ~ A9eM ~ PrIM your name and address on the reverse s . ^ Addressee so that we Can return the card to you. ece ved by (pri n ted Narne ) C. f D r~jj; ~ Attach this card to the back of the mallpiece, ' / / / ~~ d /v/!w/ ~d A~ rf space permits. or on the fioM D. B delivery etltlress digeren[ from item 14 ^ Yes . Ankle Addressed to: N YES, emer delNery address bebw: ^ No 3. Service Type '" O Certlfled Mall O Egress Mall ^ Registered ^ Return Receipt for Merchandise O Insured Mall ^ C.O.D. 4. Restrkted DeINeM tF.^^~--,-_ ^ Yes ~. Article Number - 7~~8 1830 -y586~ X312 _ ~0~2._--- (rransferiromsem~eran ~ lbme,ac Return Receipt 'S Fore 3811, February 2004 tozs.95o2+.wt54o ~ Complete items 1, 2, and 3. Also complete kern 4'rf Restricted Delivery Is desired. ~ Print your name and address on the reverse so that we can return the card to you. ~ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to A. ^ Agent B. Recewed by (Printed Namej ' I C. Date of DelNery D. N delivery adtlress difierr~it from Item 1? ^ Yes If YES, enter delivery address below: ~ ^ ~No 8. Service Type ~~ - ^ cerrmed Mall o F~ress Mall ^ Regstered ^ Return Receipt for Merchandise ^ Iraur~i Mail ^ C.O.D. 4. ResWCted DelNeryl (Fxha Fee) ^ Yes . ANGe Number _...__ .-. ~_ __ __ _. _-. (gans/er horn serv/ce label) 7008 1830 002 5860 0343 _ --- _ . -- ~S Form 3811, February 2004 Domestic Return Receipt tozsss-02-M-ts4o., m Complete Items 1, 2, and 3. Also complete ttem 4 if Restricted Delivery is desired. o Print your name end address on the reverse so that we can return the card to you. o Attach this card to the back of the mallplece, or on the front If space permits. i. A"ICIe Addressed to: 2. Artlcle Number (rlansler from s PS Form 3811, February 2004 Domestic Return Receipt o Complete kerns 1, 2, and 3. Also complete kern 4If Restricted Delivery is desired. o Print your name and address on the reverse so that we can return the card to you. o Attach this card to the back of the mallplece, or on the front If space permts. 1. Artlcle Addressed to 1, February 20D4 Domestic Return Receipt i , ^,t a Service type O Certtlletl McII ^ Equasa Mell ^Reglstere`d`_> .O~Retum Receipt for MerchandLst ^ Insured Mall ^ C.O.D. 4. Restricted Delivery'! (Extra fee) ^ Yes ~ 2. Article Number ~ , -' ~ - j (!Fenster fmm service lacep 7 0 8 18 3 0 0 ~ ~ 2 5 8 6 0 0 3 2 9 __ tozs95oz+n-tsao f PS Form 10?595-02-M-[5! A Signature - ^~.,' / ~- ~ ;. ~ (/~~C~ ~ 1 ^ Agent ^ Addressee ,{ o Complete kerns 1, 2, and 3. Alsocomplete Item 4 K Restdcted Delivery Is desired. o Print your name and address on the reverse a Signature I t ~'! ' ~~~~ ~i Q,~. ~~t~~-- ^ Agent ~ Address 8. Recehred by (Pdnted Name) 111 r II ~ C }'t FFl `" C. Date of Delivery ~ so that we can return the card to you. o Attach this card to the back of the mallplece, or on the front If space perrnlts. B. ReceNed by (PAnted Name) l ~~ ' /~ ~ ~ ~ C. Date of Deliv ^ Y ^ D. Is delNery address drcrerem from ttem t? If YES, enter delivery address below: es ^ No 1. Article Addressed to: - ~ . Is delNery address differem tram I[em t9 If YES, enter delivery address below: Yes ^ No ' b ~y i. 3. Service type !" ^ CertlHed Mall ^ Express Mall ~•. ^ Registered ^ Return Receipt for Mercfrandlse ^ Insured Meil ^ C.O.D. 4, Restdcted Dallveryl (Extra Fee) ^ Yes 2. Article Number (nans/erhomservlcelabel) 7pp8 1,83A 0002 5860 X299 -PS Form 3811. February 20D4 Domestic Return-Recelot A SI a ~~/J X o Y/~ ^ Agent v~ ~ ^ Addre~ Igi,Re slued by (Pdnted Name) f f j D~f Dell D. Is delivery address different fiom Item 1? ^ Yes If YES, enter delivery address below: ^ No o Complete ttems 1, 2, and 3. Also complete ttem 4 tt Restdcted Delivery is desired. o Print your name end address on the reverse so that we can return the card to you. o Attach this cans to the back of the mallplece, or on the front If space permits. 1. Artlcle Addressed to 3. Service Type ^ Certlfled Mall ^ Express Mell ^ Registered ^ Return Receipt for Memhendlse ^ Insured Mall ^ C.O.D. 4. Resdcted De1NeM (Extra Fee) ^ Yes 708 183 002 5860 X336 12. Article Number J (Iians/er Irom service labeq 10259502-M4540 : PS Fnrrn .4A11- Fwhmarv 9nnd .. I' r 3. Service lypa O Certlfled Mall O Express Mall 1 ~~^ Registered ^ Return Receipt for Marchand ^ Insured Meil ^ C.O.D. A na ~ Agent ^ Addre, Iv by (P to Name) C. a of D II D. Is delNeryeddrass~E from ttem l 7 ^Ye I1 VES, epte`r°dellvery edUiess bebw: ~o 4. RasWcted DelNeryl (Extra Fee) ^ Yes 7008 1830 ~0~2 586a 0305 nnmrwfirt RMUm erninf ~mc s.in.u.• Tiersa Silcox 10501 School Parkway Indianapolis, Indiana 46280 We own the property at 1207 Orchard Park North Drive, Indianapolis, IN 46280, which is adjacent to your property. We are seeking a use variance from its present residential zoning, We are required to notify you of this fact as well as the hearing date in front of the Board of Zoning on Monday, May 18, 2009, 6:OOpm, so that you are aware of the date, time and place you can come and give input or submit written comments prior to that date. We are seeking to use this property as a second kitchen to be used for midnight heat up for breakfast. There will be no structural alterations made to the property. There are no employees and no customer pickups at this second location; thus, street parking will not be greatly impacted. We are simply turning our garage into a home office. If we were not exceeding 15% of our total square footage we would not need to obtain this usage variance(Chapter25). I received your name and address from the Auditor's Office who proved a list that I was required to obtain of all adjacent property owners. I am enclosing a copy of the public notification that was published in the Indianapolis Star on Wednesday, April 22, 2009, which contains all the pertinent information to the public and for you as the adjacent property owner, including the relevant docket numbers assigned to this matter. My petition may be examined at the Carmel Department of Community Services, Office of the Board of Zoning Appeals. The meeting, should you wish to attend on May 18 will be conducted at: Council Chambers Carmel City Hall, 2nd Floor One Civic Square Carmel, IN 46032 Written comment, should you wish to submit them, should be sent to: Carmel/Clay Board of Zoning Appeals c/o Connie Tingley, Secretary Carmel City Hall One Civic Square Carmel, IN 46032 You may reach us with any questions at: 1207 Orchard Park North Drive Indianapolis, IN 46280 (317) 815-9909 (home) haoovevervthing(o.sbcplobal.net (email) Sincerely, '~F ~ C oo~sF~Fd Allyson & Clay Milender ~~~ I ti ~ ~ ~1` I(iI t II~~ ~ ~~~,. ® Ifj ~I~(~e ~ I , ~~,d~~~ .. i , m ~ ~ fl „:.T ii.' ~s ~ u) Postage $ 0814 p Cenitletl Fee 11' p p Retum Receipt Fee (Endorsement Required) Postmark Here .. p m ResMCtetl Delivery Fea (Entlwsement Aequ)red) ~ Total Postage & Fees ~ ~~P~~.~9 O Serif TO ~ G.$'. !'~'C - U~ p M1 -uhreet. Apt No.: "'"--------------- ----- wPoBOxAb. L0~0I ----------- -----------------------'-- i P~kw<y ~C~S ---..-._ cuy. scare, nP+a -- ---------- • ~•d/~/s :., - -.--------• ---- ----- ' ' - - 7~/ ytzd'o - ,p Ire, b ~ °,.r--^~f..,,..yP ,,.}} tt V 11111 r• 1 ~~4 If~~l ~ T~f~ YiY"~irlfP'1M r.$$$.,-,.,.,-r,~.~.,-~,. Il ; y}~t ~~li flex ~~ ': 7° ®~IIIP'11' i ~ fh' 8 ~ ~ 7 ~ ~' ~ ~I) ~I . i ' a~ N ~ ~ p .: . I 4 ~ L ~ ~' o INDIANAPO IS N b2 80 r, -, . ~ t-n Postage a 90.42 0814 ~ Cenitletl Fea ~~•~ 11 ~ 0 Retum Receipt Fee Po~~ rk p (ErMOrsemam Required) 92.20 O Restricted Delhrery Fee (Endorsement Required) ~~(~ _ m ~ ra Total Postage 8 Fees d. .y ~~~' ~ (~('~~'~ ~ SavN TO V 7.~ r n1 OM1 orr PO SOx~NO.~ Z-Z f z t/ ~ ~. 1`r r - --- - ----------- .- Z---~ ~-----~5 ----~ Glry, Stare, Z/PW ----- i~T -Y6-~ ~ . :rt . • C ' ~ ®. ~ gill I ~i~T~-~ il~P~ft~F~Y~ jl~~~ ~S¢~€ x > k m ~ ~ ~ ( ii ~ ~~ rn ~,;:^ p L INDIANAPOLIS I o, +~-~ ~-. ~ Postage $ 0814 to fIJ CerligedFee 11 p Posmark p Rehm Receipt Fee ~ Here p (Endorsement Required) Restricted Delivery Fee p (Endorsement Requiretl) m ~ Total POStaga 8 fees ~ ' ~ • 04~20~2009 ra ~ Sent TO ~' b ~ C/ ~ Z(-~ 111/•1 ~-..'~J ~ . M try l7 Street, APt. No.; -7 rC1• - - ~ C- .-' - - / !`' or PO Box No. (Z- ~ - / G - - he c- K N--- ---------- - ---------- -- - GYry, State, ZIPS-0 ~^ J e t) p r r s•I P l .... - .... . rr- 4 RECEIVED MAY - 8 ?p09 DOCS 7 7 •, ~~ q- 7 MOBLESVIl1E I6 7 7 Postage 7 $ ~ CeNfied Fee ~ Retum Receipt Fee ~ (Entlorsemein Requiretl) Restdpetl DelNery Fae 7 (Endorsement RegWred) l 7 Total Postage & Fees 3 aa 4 0814 11 Pas&nerk , Here ~ sent TO ~~~`' Zb~Z Street Apt NO.; ,/~ .+~ or PO BOZNO. i- V OTC ~ V -----------------~--------- ~----i~----- ------, City, Slate, LPW ~~._ ~ S~ f ~ •. - I• m o IS,-; o ;~.~ ~ ~ Pos~g¢ $ tll fl.l Certiged Fee ~ ReNm Receipt Fee ~ (Endorsement Regwretl) O flesldctetl Delivery Fee p (Endosement Required) '' m ~ Total Postage 8 F¢es ra Sent To ~/p~ __ _ O Siieei, Apt No.; I L M1 orPo Roz NO. ___1 0.., Cl1y Slefe, ZIP+4 ~]~ ~..- 40.42 0814 42.70 11 Postmark 42.20 Here 40.00 45.32,, 04!20/2009 b DATE TAKEN: 3 ' 3/- O Q TIME TAKEN: /a : 3 V NAME OF PROPERTY OWNER: NAME OF PETITIONER: ~ADJOINER , FILED (NOTIFICATION LIST), '~ ~ MAR 31 2009 I~~` ~'r' ~ "~ ~` I ~ AU 0~1 IL W F~ f~d ~.,a~a. "y'YliQs.,u 11.h~ LEGAL DESCRIPTION OR PARCEL NUMBER OF PROPERTY: /~• /3 -/~. b ~ _o~. oo% moo ZONING AUTHORITY APPLYING TO: (SELECT ONE) ~* CARMELBZA: ~`~~ ~°~~" ~'~ CARMEL PLANNING: ~ ~ r CICERO: ~, FISHERS: ~ ~ ~ ~~~ ' ~~ HAMILTON COUNTY PLANNING: _ NOBLESVILLE HOME OCCUPATION: ~~I' NOBLESVILLE PUBLIC HEARING: WESTFIELD: SIGNATURE OF APPLICANT: DATE: .3 `,~ /- oq NAME AND PHONE NUMBER O PERSON TO CONTACT: ORDER TAKEN BY: ~- _ ,:`i ,., - F ilsi I. ~/7-d ~s 7S/Zy ,I I t~ ,i. ,,>, ' NOTE' - DUE TO VOLUME AND TURN AROUND, ORDERS TAKE 3-5 BUSINESS DAYS FOR PROCESSING. TRANSFER AND MAPPING WILL APPROPRIATELY NOTIFY THE CONTACT WHEN THEIR ORDER IS READY TO BE PICKED UP. HAM/ETON COUNTYAUD/~R • I, DAWN COVERDALE, AUDITOR OF HAMILTON COUNTY, INDIANA, CERTIFY MY OFFICE HAS SEARCHED OUR RECORDS AND BASED ON THAT SEARCH, IT APPEARS THAT THE PROPERTY OW NERS IN EXHIBIT A ATTACHED HERETO ARE ALL OF THE ADJOINING AND ABUTTING PROPERTY OWNERS TO THE REAL ESTATE MARKED AS SUBJECT PROPERTY. THIS DOCUMENT DOES NOT CERTIFY THAT THE ATTACHED LIST OF PROPERTY OWNERS IS ACCURATE OR INCLUDES ALL PROPERTY OWNERS ENTITLED TO NOTICE PURSUANT TO LOCAL ORDINANCE. ANY PERSON SEEKING A MORE ACCURATE SEARCH OF THE REAL ESTATE RECORDS OF THE COUNTY SHOULD SEEK THE OPINION OF A TITLE INSURANCE COMPANY. DAWN COVERDALE, HAMILTON COUNTY AUDITOR DATED: /~- 3/j~/0 f ne provisions or moiana cone ~-ia-t-t-(eJ, no person other to zed by the county may reproduce, grant access, deliver, or sel on obtained from any department or office of the County to any partnership, or corporation. in addition, any person who rmation from the County shall not be permitted to use any addresses, or data bases for the purpose of selling,, or soliciting the purchase of merchandise, goods, services, or ,give away, or otherwise deliver the information obtained by ieesday, Math J/, M99 Page 1 011 HAMILTON COUNTYNOTIFICATIONLIST PREPARED BY THE HAMILTON COUNTYAUD/YOBS OFFICE, DIV/S/ON OF TAX MAPPING PLEASE NOTIFY THE FOLLOWING PERSONS 17-13-12-02-02-001.000 Subject Milender, Clayton 8 Allyson 1207 Orchard Park Dr N INDIANAPOLIS IN 46280 17-13.12-02-01-024.000 Neighbor Stamper, Suzan E 1222 Orchard Park Dr N INDIANAPOLIS IN 46280 17.13-12-02-01-025.000 Neighbor Silcox, Tierra L 10501 School Pky INDIANAPOLIS IN 46280 17-13.12-02-02-002.000 Neighbor Huffman, Lloyd D 8 Geraldine A 1237 Orchard Park Dr N INDIANAPOLIS IN 46280 77-13-12-02-02-015.000 Neighbor Carmel 2002 School Building Corporation PO Box 10 NOBLESVILLE IN 46061 Tuesday, March 31, 1009 Page I oj1 17-13-12-02-02-033.000 Neighbor Madru, Anissa • 10495 Orchard Park Dr W -~ INDIANAPOLIS IN 46280 -~~ 17.13-12-02-08-004.000 Neighbor Hooper, David G 10586 School Pkwy - INDIANAPOLIS IN 46280 17-13-02-02-0B-005.000 - Neighbor Walborn, Brian T 10498 Orchard Park W Dr INDIANAPOLIS IN 46280 Tuesday, March 31, 2009 Page 2 oj2 001 I I 001 002 I 003 I 004 005 I 006 I 007 I 008 I 009 010 007 I I 002 I I 026 002 003 004 ___J 005 24 023 022 021 020 019 018 017 003 2g 004 02 ~ 0~4 005 006 007 008 OS 001 006 03 007 032 . 031 008 009 030 029 015 028 ...... _~....y.. .n .. u~wo ic.v ~.vt r m ~! • Home Place Areo City of Carmel / Clay Township Officio/ Zoning Mop -~x - - -~,. - - - - ; -fir; ,~ 1:.~ r! r~ t , I i ~, ,+~- ~- S,n, ~ t` _ YC[L ~ ' ! ~ _ ~d ~ ,y -t emu-! :i 77 ~ ~ ~~ ~ >-. 6 ~ I ! f 'Y _ ,,,_ .,., !,v`e,. li sr 1`~sr. 1 a~i'. ~ C].~ ~ ~ B-2 ~y ® B-3 ~K w~ A I ~ - _.r. ~ r+~ ^ B-7 s ` , , I rr. °- ~~ ~i ~ ~ ~(~y ~~ gr st ~ f ® P2 ;, -rr ivy ~ iu E '~ r 1,' ~ V { t < ~ ~ '1Y ~t 1 ~ r ~ 1 ~~ 'J1.{ 1 u. 1 ^ I-~ iii ~ a- x K ro ~ r'~n I 1 ~. i Rli ~~ vnry - ~ k S ' ' 'I ~ M 3 ~ t !_ - -r ~ Y g : w~ ~1 ~ - - r y , ~ -. ~ ~ . ~ I ; ~;~ , t,4~~ ~; , I {' !~ ~(Il~m -,t~`'/K 4. ( "~ ~~ 3C ~~~+-~~ [t x'.1,1 {.: ~~r.-r- i i t ~-~ ;_j ^ R-1 1 tl > ~ ., r~~ s. : 1- ~ ~ 05 R STS ~, :. ,Y,Lt_..; t~ ~.. - a ^ R-2 . ~ _ ^ I'-~~va ~ - ~ ~ f~~ . ~ ' 1 ~ R_4 ~ .~ ~ tt ~ ~ r -fC t.(P c, .~. 1-- ~ r a ^ 5-1 C ' ~ ~ y - HM000 t - ON' t ' i ^ icu~ ~ m ~ w~om~ I 1 ~~ ~ L ~ 4 ~ -{- -~~ ~~I, ! ~ ' .-fi I ® U53a CpWOOR ' gg g :. : ~ ~ .- i~ 3~1 1 ~ _-1 I ~ ' + 1 1 ST ~'4 ~` -1 ' ::~ th~ '- 1 ~- : u ' '~t ~ x~'. _! _a _!1 1 ~I I _____ _________________________ __ Produced g' City of Cormel GlS HOME PLACE DISTRICT BOUNDARY for tie De rJm M mm M i f C S _1 Jl~s~~ ,~! po y e o o u e rv ces 4 4 J / ~~---- HOME PLACE BUSINESS DISTRICT OlflGal Zonirg Mop os adopted by RESOLlf7lON NO.CC-lI-05-02-09 Based on property dolo provided 6y (!/05/2001 RamlNan County, lndlano GIS Produced: 07//9/2001 Last Modified: /1/29/2005 PRESCRIBED BY STATE BOARD OF ACCOUNTS NERAL FORM NO. 932 RECEIPT ~ n p ~ O ^ } HAMIL~N COUNTY AUDITOR Jv [ ~~-" "~ y ~ /- ~ FUND ` /1 NOB LESVILLE, IN, ~~~/ 20~.~-~~~ RECEIVED FROM I ~~ + ~~/l~vt- $ ~ ,, t!,~~} J THE SUM OF ~ lip (~i.:1 DOLLARS //' goo G% ~- ( ON ACCOUNT OF r.~!'V ~~~ PAID BY: ASH ^ CHECK ^ M.O. AUTHORIZED SIGNATURE O (- ' Q m ~ V z~=_~ o'~m~ Z~a^ O i J_ 2