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. . .
form Prescribed by 31a1e Board of Accounts BOVU. 81'8l""', Muncie. In
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
o
QEBERAL FORII BO. 352 (REV. I U7l
C1~
N~ 1594
FUND
CARMEL IN., ~'5"""' 201;;:) \
RECEIVED FROM _~_~ ~<.o Q~'1DL6"1
THE SUM OF ~~ ~~ ~ ~"'~-r-) ~J::> .,..,~
~ P\,-J'-C
~ &u ~<:..D ~t\-~~
s (p ~ /2JZ::~
DuttARS
100
ON ACCOUNT OF
--
E.F.T
c.c./a.c.
OTHEP
PAYMENT TYPE III AMOUNT
CASH CHECI<U ~;;). ~M.O.
