4500445684 10/07
COMMONWEALTH OF PENNSYLVANIA STD—52l

REV. 12-88 PUBLICATIONSAUTHORIZATION AND INVOICE 

# 152199 PUBLICATIONS AUTHORIZATION (To be completed by agency)HEREWITHISENCLOSEDCOPYFORPUBUCATIONOFADVERTISEMENTFORPROPOSALSTOTYPEOPAD

[] EMPLOY []PURCHASECONTRACT5ELLCLASSIFIEDLEGALNOTICEPUBUSHADVERTISEMENT(NO.OFTIMES)MAXIMUMNO.OFLINESDATEORDERNO.

1 December 6, 2009

DATES OP INSERUON SIGNATURE FOR AGENCY December 10, 2009 You, as vendor, are authorized to publish this advertisement in your newspaper, subject to the terms of this order, as

follows: Advertisement to be published in regular advertising columns, no position specified; captionof two lines arid signature

to be in capitals arid subje€t matter an title ofofficeo be et solid in typçgj_by_yr newspaper for public (legal)

notice advertising; charge to be made at the rate charged to and paid by commercial advertisers for matter similarly set and

occupying similar space; advertisement to be run in the editions specified above. Vendor agrees that, in the performance of any

contract awarded to it hereunder, said vendor will not discriminate against any employe or other persons on account of race, color,

sex, religious creed, ancestry, age or national origin and that the Commonwealth, upon receipt of satisfactory evidence of such

discrimination, shall have the right to cancel said contract. Return this copyat once if you will not accept this advertisement underthe terms

set forth. Proof of advertising in the form of a tearsheet must be included on Parts 1,2 & 3. Return original and two copies (signed

by the editor or publisher) to Agency listed above. Part 1 must be notarized. Part 4 is yours. Commonwealth to be billed only for actual number of printed lines published. Com of Pennsylvania County of Before me, the subscriber, a Notary Public in and fyi said Couy, personally came __________________________________whobeigdulsw ii, doth depose and say that he is’_________________________________________________________________

the a general newspaper published at 3L/t d

eti-”

that the advertisement, (f which tearsheet is attached: hereto, was published in the regular advertising coljmns of said newspaper,

in the editions of said newspaper, in all respects as ordered and invoiced above; and that the Commonwealth is not charged

therefor at a rate higher than is charged any ordinary commercial advertiser for a similar amount of matter occupying similar space

and set in a similar manner, in said newspaper. Sworn and subscribed before me this 1

day

of .%Q,,c_q 201(3NOTARY PU Mycommission expires
‘This affidavit must be made by the Owner, Pubü’her, or the designated agent of the owner or publisher.

TO:(NAMEANDADDRESSOFNEWSPAPER)

Centre Daily Times P.O.. Box 89 State College, PA 16 8O4.•FEDERAL ID.NOjSOC.SEC.NO. FROM:(NAMEANDADORESSOFAGENCY) ENCYTELEPNONENO. Yvette

N. House 717—787—9495 Bureau of Air Quality 12th Floor 

# j. Harrisburg, PA 171D9

ACCOUNT CODE COST FUNCTION 

# V PASTE TEARSHEET HERE MENTAL ‘qONAL _4•_— /._— OF PENNSYLVANIA Notailal

Seal Amy

D. Sinclair, Notary Public College

Twp., Centre County

MyComm!E&on Expires Mq. 14,2013
IMflr1D‘LIr’LfTIAPIC’ AITrA