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DEPARTMENT OF COMMUNITY SE I :ES
,---) N'° 758
FUND
CARMEL IN. , _.) 1 CTh
.7-..,-.._MDHTH DAY rif.Aft
-RECEIVED FROM '
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THE SUM OF \-- . ,;,-- \, ,-Li,- c..-.,--.p er ;-_-,_, -k- 7 k -1 . rx* C:*--- `' \1 oo DOLLARS
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ON ACCOUNT OF -----r--- \& - :::,- --- ,.
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PAYMENT TYPE&AMOUNT
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CASH CHECK kr:;7i- joo. . -*----• -.-....,. 7...
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E.F.T. C.C./B.C. OTHER . AUTHOt!ZIBIGNATURE
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