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Porm Prescribed by SIGle Board 01 AccounlS Boyce Forms Systems. MUllets. III
GBHERAI. FORM NO. 3152 (REV. 1887)
C ) RECEIPT C:J
~EPARTMENT OF COMMUNITY SERV~S
N~
2464
~7lj?~
FUND
CARMEL IN.. /-- c2 7 20 10
RECEIVED FROM, ~.e'~~~ LL '::-__ . .._ $ "1&7;1 ~
THE SUM OF /~__L_~_>~~ o/-ff%D "----------"------"~
/#' A ." OLLARS
ON ACCOUNT OF / J'/ -OOt 0)0 ~?;rMc.... . 100
PAYMENT TYPE III AMOUNT
CASH CHECK X' 6-JI'M.O.
E.F.T.
c.c./a.c.
OTHER
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