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Form Prescrlbecl by Stele Bocud of AccoUll~ Boyce Forms Syatems, MUIlclL In
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FORM NO. 352 tREV. U")
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1731
FUND
CARMEL IN.. ~~, 16L-
RECEIVED FROM ~ ~~ ~Yv\~ $lG,S.~~
THE SUM OF ~~ ~t-=S~ ~\f~-'F-~ ~ ~-...J-DOLLARS
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ON ACCOUNT OF _I \ ~--<C:3 \ ~LS Q. ~ L ~-~
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PAYMENT TYPE a AMOUNT ~~ - ~ _
C:::SC~':TH" -~"'D' ,,_~;;-
200'
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CASH
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