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FormPr"~"bY'litaieBoOrd,;fAe.i. 'BQYceFi>~.sYet_.'Kim!ll.; 1.. QRECEIPT U DEPARTMENT OF COMMUNITY SERVICES ~"NERAL"ORM --NO.' 3112 '(Aiiv. '''.'1 ~:~.,....t.e......... ". . .<:....- Ng 2347 :'t ) ,FUND CARMEL IN~ ""'?"~~pr) b_ 20 Dd, , ) "......' /. RECEIVED FRO~ ~.:~;:.:;~ )~i,~'c-:':I{:: ",.~~A-.'~.A' ,,- ./---J THE SUM OF ",,",?:;/L~~ ;{<.-.,. :~<-, C. 90"///S,: C,. ON ACCOUNT OF ~) J .. CC>\ :2. t:." .,;> '.';',:-; .,..,.~"--,.I' ~.~', ____ $ "r.::}:' ~.:-~- :.......: -- DOLLARS 100 r<; ..!~ c.s .?" u:r /1 /1;'::;-: /1, .' PAYMENT TYPE It AMOUNT .. y."',/" 1/),.~~~2: CASH CHECK M.O. "~.:.:::::~:~:+_;;:E:;>:;,.,....:.~'t(t',:)/"\ < -....... AUTHORIZED ~;GNATURE' ~F.T c.c./a.c. OTHER