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HomeMy WebLinkAboutReceipt u Q ., Porm Prescribed br SI_ Board of AceollDla Boyce Forme SystemS, M1DICIe. ID RECEIPT DEPARTMENT OF COMMUNITY SERVICES Q, ~L-- GEBERAL FORM RO. III (REV. '''71 N~ 1826 F~ND CARMEL IN., ~rL- /4 .20~ RECEIVED FROM ~<~ \Y\~.~~~ THE SUM OF ~,')... ~t-l~ ~\.~\'1 ~.Q~ ON ACCOUNT OF ,4~-o, ~~ ~~~~ _ ~~~';;'O PAYMENT TYPE a AMOUNT ~~ Q~l ~~ ~Q(.1I CASH CHECI" .Q~(? M.O $ tt~l~ DOLLARS E.F.T c.c./a.c. OTHER