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RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
8EIlIRAL FORIIIIO. 312 lREV. '8171
N2 1816
FUND
20~ /
RECEIVED FROM ~-:s. 6A-c-'r L R sl/fOI\~S
THE SUM OF ~~~~~~~~~. D~ ~~DOLLARS
ON ACCOUNT OF \~S-(Ol ~~~-~P.O'l~-c:::::. ~~~t~c...o
PAYMENT TYPE a AMOUNT ~~\ C-.o l....-A--~tlr ~lL...LA;,. Pu L:J
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