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Form Pres"rlbed by Stale Boarc1 of Ac:"ounts Boy"e Forms SyetelllS. Muncie. In. .' .,. i . .'
RECEIPt / C)
DEPARTMENT OF coM Mt)NITY ~RVlcES
GJENERAL FORM NO. 3!'J2 (REV. 19971
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2352
FUND
CARME:L IN.9,h-- P 20 D~
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RECEJVED FROM ~<L~,~.I;' >~",.f~....., $ / .:;:736.00
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THE SUM OF (s:-.d)-L<<. c-:..../':c,p.,_;;.;,.,,'--T:.....<..c....A;...........(."... .Lt'....../... . /-[jOLLARS
. ::'_;. '. .~..'. d .' .' ,t> 100
ON ACCOUNT.QF .,<::;> 7--c.',;;;" -L),.o/r;'~C'/F~.l / A..t)L..,s ;// (' ....:17... ..J
PAYMENT TYPE III AMOUNT
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CASH CHECK;~ V'.. M~O
E.F.T c.c,IB,c~ OTHER
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