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Form Prescribed b, Stale Board of Aaeounls Boyce FormeUm.. Muncie. In (..,,)
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
CL~ ~I \;:-~ND
CARMEL IN.. ~ .? 20~
RECEIVED FROM ~ G: \ e:-h
THE SUM OF C ~ '\-~'^':>~\ 'EG"" l~~~D ~1
ON ACCOUNT OF OC\.~ol ~~L-S.I ~9-~\~1AJ
PAYMENT TYPE a AMOUNT -fY\ r;;: I
CASH CHEcK2B8 8 Lj~M.O
GENERAL FORM NO. 35% (REV. 1111'1
N2 1536
SI,3?,iJ.(J)
,
~
~!l 'DOLLARS
100
"I;. T
c.c./a.c.
OTHE~