DOA-3417 Application to Certify Newspaper Legal Notice Rates 10-2024.docx

STATE OF WISCONSIN

DEPARTMENT OF ADMINISTRATION

DIVISION OF ENTERPRISE OPERATIONS

DOA-3417 (R10/2024)

AUTHORITY: S. 985, WIS. STATUTES.

STATE BUREAU OF PROCUREMENT

101 EAST WILSON STREET, 6TH FLOOR

POST OFFICE BOX 7867

MADISON, WI 53707-7867

VOICE (608) 264-7658

http://vendornet.state.wi.us/vendornet/paprates/5a.asp

Application to Certify Newspaper Legal Notice Rates Instructions: State of Wisconsin newspapers must apply to receive any compensation or fee for publishing legal notices by completing this form. To renew your certification or apply for the first time, please complete all five (5) sections of this form.

After renewal, if you need to update your information, only fill in the spaces on this form that apply to the change(s) and submit ten days prior to the effective date of the change so that new rates issued by the Department of Administration can be sent to the newspaper.

Return all of the required documents to the address above by US mail.

**Place of Publication, as defined in Wis. Stat. § 985.01(5)

**Areas covered by Newspaper (list all cities, towns, and villages which your newspaper provides circulation)

Column Width (measured in picas) ** Please Verify Column Widths and Font List **

Col Col Col Col Col Col Col Col Col Col Col Col Col Col Col Col

New applicants must complete the section below. Renewing applicants should skip to Section 2 unless changing or adding fonts.

ONLY if you are changing or adding fonts, submit a SAMPLE of the fonts. A font sample consists of three (3) alphabet lengths a through z in lowercase, repeated in one continuous line. The sample must NOT contain kerning, ligatures, and must be flush left (ragged right) e.g.; abcdefghijklmnopqrstuvwxyzabcdefghijklmnopqrstuvwxyzabcdefghijklmnopqrstuvwxyz One sample of each point size and style (bold or italic) must be submitted with name and size of font on a separate sheet.

2. Parent Company Information: (if different than #1 above)

Have you submitted the completed DOA-6448 Taxpayer Identification Number Verification form?

|_| YES |_| NO **Please verify TAX ID # for both Newspaper Company and Parent Company**

3. Required Verification of Paid Circulation:

To verify your newspaper’s total paid circulation, you are required to submit one of the forms listed below every year from an independent third party. The State of Wisconsin Department of Administration requires the most recent 12 months of your paid circulation numbers on or before the 15th of October of each year. This will certify that your publication meets the requirements of Statute 985.03.

|_| United States Postal Service Statement of Ownership, Management and Circulation (PREFERED) (All Periodicals Publications except Requester Publications) PS Form 3526

4. Required Sample Please scan as much of a full page as possible of your newspaper that displays your legal notice or classifieds section.

5. Certification By signing below, I certify that the newspaper named above meets the criteria in Wis. Stat. § 985.03(1) and that the information I have provided in this application is true and complete to the best of my knowledge. I understand that any false, misleading, or missing information may disqualify me from consideration.

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