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Form Pri98crlbed by State Board of AccoUnt. Boyce Farm. System., Mucc\e. In.
C 'j RECEIPT -c'J
~PARTMENT OF COMMUNITY SERVI~S
GKNE"AL PORM NO. 3!1Z (REY. '.V7)
9!-~?t-<!A.'''~
N!!
2420
FUND
CARMEL IN.. /.;;1. -~ 20~
RECEIVED FROM M~ ..f-~~
THE SUM OF ~~t7'
ON ACCOUNT OF /1'9-00}. A..2)~ A/Y)6'A~1
~
~. ,~ .~--:J.d
PAYMENT TYPE a AMOUNT. ~
CASH CHECK,X ~bM.O.
$ 3Gc.. 0<::>
~~-~
" .n> ~DOLLARS
10
~-~ ~ -jJ\
11 ..z.-. .........
AUTHORIZED SIGNATURE \
E.F.T.
C.C.fB.C
OTHER
I
L._