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~ Form Prescribed by State Board of Accounts Boyce Forms System.. Muncie. In. QIKNBnAL PORM NO. 392 CRIltV. IDD7) () RECEIPT ( . J ~EPARTMENT OF COMMUNITY SERvretS N~ 2426 $ 3Q 6C -. ~ THE SUM OF './') 1t'17 DOLLARS ON ACCOUNT OF &J:~-,Ji.~f/}7,o/.Gi qw /,-{j4><k~~ PAYMENT TYPE.a AMOUNT &~}J3 /"Y / 7(;,- oc:( /fj)ts ,.{/7Jlfkl,f CHEC(/6f9;( M.O. . -== . ~~ I ~~p - AUTHORI~ED "TURE '\ C.C. B.C OTHER CASH E.F.T. ['