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Form Prescrlhed br Slate Board of Accounts Boy"~"Dl8 System.. M~ In RECEIPT
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lIERERAl FORM NO. 3U (REV. 1"'1
DEPARTMENT OF COMMUNITY SERVICES
N2
1607
a~ FUND
CARMEL IN.. ~ ~. l~ocS:J ,
RECEIVED FROM ~~ ~'?~ ~Q)l~~, L.~. $D2I'~5.a0
C \
THE SUM OF \ W"D ~~~~ {j~ ~""~\~to;....I_r;tfr ~t:>~DOLLARS
ON ACCOUNT OF S'I-'2>\ t>? Q..""-"",,,,-- C~ 0:1'6-
~S<- ~hf>..LZTt~d l~,-\.~r
PAYMENT TYPE a AMOUNT
.' "I ".-1 0....
CHECK c?C C--J M.O
E.F.T.
c.c./a.c.
OTHEfl
CASH