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Form Prescnbed by State Board of Account. Boyce Forms Systems, MunCle. lD
.,
. -~', RECEIPT U
UOEPARTMENT OF COMMUNITY SER~CES
ClIlHERAL FORM NO. 352 CREV. 1087)
k~~
N! 2338
FUND
CARMEL IN.. /1'/1 20"Z-
RECEIVED FROM ~~~ sr.~~
THE SUM OF JM.e ~dud/~)L "5'~
ON ACCOUNT OF I~ - 0;7.. /I- DL S l1UA/f...tt
PAYMENT TYPE a. AMOUNT '"71~ ~ .
CASH CHECK ( f? 'I-'I.;z. lie.
o c'
$ 3S0 .-
DOLLARS
100
E.F.T
c.c./a.c.
OTHER
