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Form Preacrlbecl br State Board of Account. Boyce Formo Systems, Muncie. In
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FORM NO. 152 tREV. ._""1
Q~
CARMEL IN.. ~'-1 \ " 20 C \
RECEIVED FROM _~)(~ f"v"\1:)c;..~~
THE SUM OF "-- ;-, \J">>-' ~~ ~ -s....?tri
ON ACCOUNT OF-.9\-c2:l\ cs. ~ f\wt_o
N~ 1650
FUND
$ S' l4!D. t)~
~~
~~ '~====-OOLLARS
100
PAYMENT TYPE & AMOUNT
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~,-6
CASH
CHECK
II S'l M.O
lS,!':.T.
C.C./B.C.
OTHEP
AUTHORIZJ:D Slc;NATU