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~1Il P,eae,ibed by Slate BoCl1'd of Accounl. BOYV SY8t....... Muncie. ill
. RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
~
llEIIERAL FORM HO. 3BZ tREV. 18171
Ce:-~~
N~
1399
FUND
CARMEL IN., r66 5" .20 a I
RECEIVED FROM ~O~"~"\ll~ CH-I"'l1'::.il~ L, -f'-~ $ '1')0 .C)u
THE SUM OF ~~ \-\~~~~ ~"t-- f ~ ~~~ DOllARS
!J 100
ON ACCOUNT OF \f,- ~~~\ 1 V'" ~.... D' I V '-1 (:)~ t:J \
E.F.T
CHECK ~5'"S
c.c./a.c.
OTHEP
PAYMENT TYPE & AMOUNT
CASH