HomeMy WebLinkAboutPearson 116.03by $tOL9 EOO[d Of RCOC1tOlf. Balm Forms ftslofns, f4unde. j0.._ bENERAL FORM NO. 7152 IREV. 1987)
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES,
N2 2733
A-0 LA 4 FUND
RECEIVED FROM _ -S
P.t THE SUM OF DOLLARS
l ( 100
ON ACCOUNT OF s
PAYMENT TYPE a AMOUNT
CASH CHECKM.O r
C,C.I9;C OTHWR I J E F.T &VrKOIt) rlaausups
a ,