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Form Prescrlbed by State Board of Accounts Boyce Forms Systems. Muncie, In.
GENERAL FORM NO. ~52 tREY, 1997)
U RECEIPT ( ')
DEPARTMENT OF COMMUNITY SE~CES
N!
2238
~ /,k:""'I,.<t/'
FUND
CARMEL IN..", '''::';~:;''Ic>('->--'
RECEIVED FROM Z2,,~~/~.~,,~. .l:>_ '''-(:~''-''-;'t~~.
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THE SUM OF ,,--..---.---r.~~'-"./;;t.?' [ (...' :,/ ,.-/';/-, ',. -/c-'D /'.."
, ,,'................ "'\...~, ::;;;;:::=:r;L.-E:,.. / " J "
ON ACCOUNT OF ~}~?"'f' :,t.:",..,,_/-~a/t....~':jL..-:-!.zc l~~2:;':.... 100
1/ ? - O~ ,f..j)( S ,4/11("' ~
20 Z'\,;,~:",
3\:::;)'-0. (~)Q
$
DOLLARS
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PAYMENT TYPE a AMoUNT
CASH CHECI(~3? / '9 M~O
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c.c.fa.c
ILF.T,
OTHER
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