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Bith. — Nikaia (Iznik): Bolatli/Gölpazarı
| 1 | — — — |
| [— — —]․․․․ν̣․․․․[— — —] | |
| [— — —]․․ι̣η̣[— — —] | |
| Ἀσκληπιοδότ̣η̣ Ἀσ̣κ̣λ̣η̣- | |
| 5 | πιο̣δ̣ό̣[του] τῷ ἰδίῳ ἀν- |
| δρὶ ἀνέστ̣η̣σ̣εν τὸν [βω]- | |
| [μ]ὸν ἐ̣κ̣ κοι̣νῶ̣[ν ζ]ήσαν- | |
| [τι] ἔτη οαʹ. |