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Form Prescrlhed by Stat. Board of Accounts BOVC.Ovstems. Mund.. la.
. ." RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
0-,~,---
FUN.D
CARMEL IN.. ~.p..,fL. 1 Co .20~
RECEIVED FROM c,"2>L~ ~ (Pt+'=i-. ~~
THE SUM OF \~~~~ r.--i ~ ~-
ON ACCOUNT OF lS4-<.or ~GrL~ ~~
~~ ~,~~.
~.
..NCRAL FORM NO. 3152 (REV. 1897)
N2
2021
$ 8-:5(!), ~
OOLLARS
tOO
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PAYMENT TYPE & AMOUNT
CASf-I CHECIU;;;)~'=)ltJ M.O
E.F.T.
c.c.fe.c
OTHER