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FotIII Prescribecl by StGle Board of Account. Boyce Porma Sl'81emo. Munale. In
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FOllM NO. 351 IREV. tea?)
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Ng 1716
FUND
<1 - ,,~ 20 0 I
CARMEL IN.. c:J- '-.:,) ~
RECEIVED FROM \ r..Y'~'I..nt\~ ~N.4>\~..~
THE SUM OF ~ ,k..=--= ~-..bD ~~
ON ACCOUNT OF.. - I o~ -Cl ~ ~ \~ ~ I ~ _..,,\::)-~\
$ t'~D_(::)d
DOLLARS
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PAYMENT TVPE' AMOUNT ~ "'2>""-",,, '--'-
CASH CHECIC1 '2:>f\ M.O