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RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
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GEBERAL FORM RO. III (REV. '''71
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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