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Form Proscribed by Stale Board of Accounts 1l0YCd rorms ::iystems. Muncie. In.
GENE.RAL FORM NO. 392 (Rav. HUt71
(\ RECEIPT ~..
~DEPARTMENT OF COMMUNITY SE~CES
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2343
Ge'l7era I
FUND
CARMEL IN.. /y2nJ;;L 2cQ3.
RECEIVED FROM ~~< C.---.<:;:zS...~~J _~ $ -'lM. "'"
THE SUM OF /" :.,':~ /~~ ~hJ -..-.--_____ ~DOLLARS
ON ACCOUNT OF /~-;F- o~ ..s'P ..
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PAYMENT TYPE a AMOUNT
rJc:" . ')~ ..-
CHEC' oa;ilS M.O
E.F.T
c.c./a.c.
OTHER
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~ A HOR'ZEO ~IGNATURE
CASH