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V..' " u ...., , ,0, .J Form PraacrilMd by Slale Board of A_II Boyce FOr1D8 Sysl_ Muncie. In RECEIPT . DEPARTMENT OF COMMUNITY SERVICES 8I!REIlAL FORM Ho.nZ IREY.. IIUI N2 1535 (\ ........._:~ /ii':)-."i;..'"f::"ilfJ",t....,.. ~UND .'-1 ,:). ~ ,20 <::) \ /\ L . -"'" r-r.">.. ,-" \.) -~. """ ~ ,_fi!!.) '""',;;..:,,1.-. 1:'_ ~ pJL I "':;'~-o..__-::. sq\\) .()~) CARMEL IN.. RECEIVED FROM THE SUM OF \~ ~ ~F'C:;",Q.~~-\'.,;".~ ON ACCOUNT OF ~-c~S-OI \ ~\ "t~__..~. ._~ ( 1 \ i"-.'''' ~\ ~._' M.O c~~_ _ ~c::.,. ,i:;;,,--.~.. DOLLARS - ~ - )9-0\ tW,t;N':::.p} '\ l Q~ T' -,_~)~2.!\ .b)L l,.!... ~ --~._-~ : \ ----:::5 -'"'-''' - ,(! \".. ,,, 4C::-.~...-..,... ~.;:.,... ~"",.._.!. "4"'C\.''J,-o...,__.'___,,~ r::::. AUTHORlfEiD SlliNATURE '---..".-...--..' . E.F:r C.C./B.C. OTHE~ I ;1 .1 I j I I I i , .! I , I I 1 :: " , ., I J I j ;1 :1 , J ! '.1