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Pal. — Hierosolyma (Jerusalem) — 5th c. AD — PEFQS (1903) 171-172 — ZDPV 47 (1924) 97, 7
| 1 | ☩ ἐνθάδε κεῖντε [☩] |
| Ἀναστασία (καὶ) Ἰωάνν(ης) | |
| Θεοδώρου, μη(νὸς) Περιτ(ίου) εʹ, | |
| ἰνδ(ικτιῶνος) βʹ, τοῦ δὲ [α]ὐτοῦ | |
| 5 | [ἔτους]. |