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Po.... Prescribed br ~ Board of AccouD18 Boyce POr1ll!l SJIIl8ID8, M1mcle. III /- , U RECEIPT "U DEPARTMENT OF COMMUNITY SERVICES l~k.jL/;l~ ll--f] CAR'MEL IN.. I l,.O1} . RECEIVED FROM THE SUM OF ON ACCOUNT OF FUND t) "f\ , UBIlRAL FO.. RO. 'U IIIBV. ...71' N2 1787 . . /ir i'n"'" .'.,~,."l ';'.. :' !,,'u $ I Y . L-'...-..~_.._..-.--....~._-,..".,-~.. PAYMENT TYPE 6 AMOUNT '/31 ~.::l /, J.....~ 'l[l' CAS 1-1 CHECfl' \/ J.!I"',I;V j M.O E.F.T Coc./a.c. DOLLARS 100 . 'l- /': .,.,. ;_-;..:.... L""~,,,_ . .,-_- I .-{.. ,n' f"A' (j' ,/~/'_,,!,,~~,/ AUTHORIZED SION!\. URE . " OTHE~ ":1: ." i ~ :J '1 1 i ., '<,1 ~j :1 :'.1 .'.! ~~4 :j :':1 :1 1 ____-J