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Form Prescribed br Slate Board of Accounla Boyce FOnn8 SYSlllDl8, Muncie. III
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FOaM NO. 352 fREV. 11171
NQ
1824
a, l~~ FUND
CARMEL IN.. ~ L~ 200 I
RECEIVED FROM~~W \.e-y-.. ~ \::) ~'V\\vn~~(Tl.V?
THE SUM OF ~~ ~N.~ ~~ *-
100
ON ACCOUNT OF \ \ -D \ ~ ~ ~ ~L:lIO~ u, S'E)l-JS
.\\-~. ~F l~~'\'Q~
~ 2:-L~-
sT/50 .D~
~ DOLLARS
lI.!.T
c.c./a.c.
OTHEP
PAYMENT TYPE a AMOUNT
CASH CHEC~M.O