HomeMy WebLinkAboutReceipt
Form Prescribed by State Board of AccOunts Boyce forms :lYB,emB, MUDCle. Ul.
U RECEIPT 0
.- - DEPARTMENT OF COMMUNITY SERVICES
GENERAL FORM NO. 392 (REV. "197)
@/Jt?rttl
FUND
CARMEL IN.. CJ:::/- jL' 20 0.;<
RECEIVED FROM~'~C~~
THE SUM OF ~~. ~r ....-../~
ON ACCOUNT OF /'fL3-c:t;;; ~ 441~/j(/
~
PAYMENT TYPE a AMOUNT
CASH CHECI<"XD9'fI~.e' M.O.
~ -4' <'
..-. . ~?~
'-~
AU THO 0 SIGNA'tURe:
E.F.T.
c.c./a.c
OTHER
N~
2294
$ ..::?~ oz:>
DOLLARS
100