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Home My WebLink AboutReceipt Form Prescribed by State Board of Accounts Boyce Forms Systems, Muncie. In. . . U RECEIPT U DEPARTMENT OF COMMUNITY SERVICES GSNBRAL FORM Ng. ~g.. ~~_... .___ N! 2340 0' " ..' I' r}.o. ,v'': / /' I ._>-~(.-- ~,.- ,"'. / ".- . CARMEL IN" FUND /l/', j I VI.>......... ." .")~, 20 (,.-i:>\ G'- /. / J' ,r, .'l,~' '/.J!' " '-,' 11 MI- i"." " "~""iP,,,,' "".,./'1' / $ "1 (J tP. 00 RECEIVED FROM,{'('.if,~"';'U:: ,:li THE SUM OF O'N ACCOUNT OF -.::-'-'<,<.,.-j::;-., .. - ". I ;:. _ i' _'l ,-l.J ; /' i..r.=' .~~~;~:.e"f'..,~~ ,_,.\ ;' 'i) tI ,. --'~.4;J'f..,," . ./.( ",,/ ,J" _ :~;;,~.~.. c:::.~,,~__.~ ""-~-"-""- . ~ .--.....-...--..... ':" DOLLARS ... '- .,- 100 .....:'~; -/;;"/-e-; /.-. /63--' /:'c::~) .. '::'j:>"::::;) PAYMENT TYPE eo AMOUNT .. CHECK ;,(/':./l .:,;" ~ 'J l c;c.le.c CAS~ M.O ~.,:c:.,;::.,;;:-.t ;,:;_~~::_;~ .<...,l....-.-- .., " OTHER AUTHORIZEq/SIGNATURe:. E.F.T