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, " fo<!ZIl Prucrlhcd ~ State Bocud of AccoWlt. BOYU. Sptllmll. 11_ In RECEIPT DEPARTMENT OF COMMUNITY SERVICES ,,0 " 8EIIBRAL FORM 110. 182 (REV. 1887) PAYMENT TYPE 80 AMOUNT 'e"'" CASH CHECK.!:t q.::J.10 (PM.O. N~ 1540 t~ t:::..- ~ ~\-,..~ $ t')r't(J .f:J2:J ~o ~o t~ DOLLARS 100 --'CJI ~\ \ E.F.T C.C./B.C. OTHE~