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Fo.... Prll8Cribed by Sial. Board .fAccoiIDlI BClTceForms Syrrt...... M""c1.. In. , ~ ...... RECEIPT ' . ~PARTMENT OF COMMUNITY SERV~S ~/',)""""-,-,,,,> L'j?" /.. ( '('FUND CARMEL IN.. ....J II /b RECEIVED FROM THE SUM OF ON ACCOUNT OF PAYMENT TYPE a AMOUNT CASH CHEC~:7Jj(~~ E.F.T. C.C./B.C . ;::;._ -t.. :__ ,"'- 20i:0 -.....:/.... . ) ~_. c::.~"(._' tr-~~_,~ .-::<'. ~-;.,; ....,,> L- / LL:. ~ ;' (.("',.,( -7~71:':((:" < 1/ {'! 7'c:...../' J /" /' . . ~;C'; ..\.. f-._..-^-..A..-e...;;-,-,~.,~~--"'...t.A_,.-r~.( --- /'J- ,,;-':.. --.::\2> ,.f ,'/A ,j/ .. " " ./" C-'C'\' ..c.r- /....' iN"- [;~'I" ~ - ,~'-'-S ./:-\ .r ~ ," c--!' <>:'"" L,"~ tfJ...C,;;:' "." ..N1tRAl. P'ORM NO. 382 tREV~ le8" / 3'3rJ $' -r- 40".- /OOLLARS 100 N!! -rL~-~:(.. <.-... . t/ M.O. ;;:::::'_'~-'~';~:~:7'J;;:=::::,,~:'l;;;)---.-. ~ AUTHORliEb SIGNATURE J OTHER 2447 00 .-",..-