| FILING FEE: $136.00 |
| *INDIANA STATE BOARD OF HEALTH $70.00 |
PUBLICATION (CHECK/MONEY ORDER ONLY)
COMMERCIAL $129.00
RECORDER $99.00 |
| APPEARANCE (1) |
| PETITION (original plus one (1) copy) |
| MEDICAL HISTORY (2) |
| CONSENT (1) |
*The Clerk will mail with check or money order