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Home My WebLink AboutReceipt V' .....0 ! ~ .; Ilorm Prescrlblld by 31ale Board of Accounts BoyOl FOrmB SVllI...... NunCIO. lD RECEIPT DEPARTMENT OF COMMUNITY SERVICES 8EIIERAL FORII HO. 352 (REV. 11.71 Ge:-W~ N~ 1684 . FUND CARMEL IN., ~\.k.c:..... .:::LL...... .20~ RECEIVED FROM~LU..V'Y\. ~-.J.. ~~~~~\ LLQ.... $~ THE SUM OF ~I.;) '\ ~~~~~ 2ICot\-"l' ..\,,~~ ~~w4-~~~OLLARS ON ACCOUNT OF Rl)-C\ ~ ~'-<> ~ lc.~ > f< 1-(:)\ Sf ~ 1ou\ tt..."l-4n- ~ PAYMENT' TYPE & AMOUNT ~ -<:)\ f.:\CLS ~4') "Stt- q S--o ~ CASH CHECK l~ M.O. ~~ E.F.T c.c./a.c. OTHER