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Form Prescribed by State Board 01 Accounts Boyce Forms Systems, Muncie. In.
U RECEIPT W
DEPARTMENT OF COMMUNITY SERVICES
QBNItRAL FORM NO. 3~2 tREV. 1887)
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2310
FUND
10 /; tp 200 Z-
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RECEIVED FROM _c:u.7--C~.L {J~ C~.<-C ~- $td?'tPS1 O)'J.-
THE SUM OF 't::__::Z"V1:J +~1-lA( (j A4~1i,ul ~,'{(;t;--4U~h1- rbo~f"&~ ----..----"
ON ACCOUNT OF I LiLl - C)[2~ ,P b-r;l fJ! 100
CARMEL IN..
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AUTHORIZED SIGNAJ"URS
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PAYMENT TYPE II< AMOUNT . \......_.X~__~1
CASH CHECK 511:.? L! M~O (j