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Form Prescribed by Slate Board of Accouota Boyce ~ Systema. MUDCIe.IJ> .. ...,. .. . . F~::
.~L, RECEIPT "~ .
'DEPARTMENT OF COMMUNITY SERVICES'
GENERAL FORM NO. an (REV. 11971
N~
1464
(3.&-e~ .FUND
CARMEL IN.. ~ / 2... 20521
W\)ll~ ~ WvJs LLG
~\ b t ~
..:J ) "X )lknd~ -;)UYTY ~ r?r---
J 100
3.2- oj ~ S'l,
~
$ ~t30 ~
RECEIVED FROM
THE SUM OF
ON ACCOUNT OF
DOLLARS
PAYMENT TYPE II! AMOUNT /-.
CASH CHEC~OOh M.O
Ck~ .~.."".
'-..
......T
C.C./B.C.
OTH'E~
1
Form Prescrlbecl. by State Board of kaOUDls Boyce Forma Systema. Mll!lcla. [n
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GEIIERAL FORM 110. au (REV. UUI
N2
1463
8 L1lL.H--t1 FUND
CARMEL IN.. fh(}va.~ 12 .2oJ2L
RECEIVED FROM tv, ) } l,.~ ere t-k LU~Jel s. LLG $3 d s..:{' ,o~
) . ~/
THE SUM OF --rAr~~ ,M1l,/!Sq r1L. -jwN h L(~rd t;f1Y~'~?DOLLARS
ON ACCOUNT OF \A~(t5 fiT (Ah) 'li.~ Cf'--O-Ju
,3:1-01 pp
C' ill~t/
AUTHOR'ZE1IGNATURE
PAYMENT TYPE II! AMOUNT
CASH CHEC~ J~f)O 2. M.O
E.F.T
C.C./B.C.
OTHER