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"RESCRIBEO BY STATE BOARD OF ACCOUNTS BOYCI fOR.S InnMs. .U"CII. .11I.
GENERAL FORM NO 152 tREV.IB'"
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
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N~
1150
FUND
CARMEL IN.. '\ ~l DU
~NTH "'^ YR
RECEIVED FROM~~ · A\c.)tlIN~
~ . Ow
THE SUM OF ~ l-\~ ~ ~ ~ (:':) - I~ -QOLLARS
ON ACCOUNT OF i" .;l~'- 00 - '\\ 4=, "'"'""'......., s"'~~:~
\ <\ d. 0<::' p.., \)U; ~ I\\~a d. 1\\ nA L~ S'ANWS I
PAYMENT TYPE a AMOUNT - "+S" t
CASH CHECK ll'-lu M.O.
$I)~O..~G
E.F.T.
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AUTHORIZED SIGNATURE