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Form Prescribed by St.... Boa:d of Account. Boyce For~ems, MUDcIe. In .
RECEIPT
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GENERAL F"1lM NO. nz CRIlV. 11811
DEPARTMENT OF COMMUNITY SERVICES
N2 1602
a~,-- FUND
CARMEL IN.. ~0~. \d--.. 20~
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RECEIVED FRO~~ ",,-, ~r\~ ~ A.<e, ~,~("
THE SUM OF \-1:::J~ ~"'~ ~''<CIi I'w;> ~
ON ACCOUNT OF "5"5""'--0' ~~L~ ~fu~ 100
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$ 2:>SD.{)U
DOLLARS
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c.c.la.c.
OTHEP
PAYMENT TYPE 81 AMOUNT ."
CASH CHEC;) 'CJ \ \
M.O