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Home My WebLink AboutReceipt Form Prescribed by State Board of Accounts Boyce Forms Systems, Munc:te. In. U RECEIPT DEPARTMENT OF COMMUNITY U SERVICES GENERAL FORM Ng, ~... .n_ _ _ . N!! 2232 @:,.)pr,n / FUND ,,;, 1 "J' -- :? .:--; .............::> CARMEL IN.. /.1/''-' ~ .~:x 20~ V. /.... RECEIVED FROM ~~~,r./[~_...l..-~-'~~-~.{~'-~ ~~.e~'L~<':'~ ,- . ','j t/{/ / t"-. ..-;,,/ / / (' . /';f TH E SU M OF \':':" --"t:..~~ _,..{:;.~u, L..L . . ~ /&: . ~.. ,..- , , ,/~.:.: f~' ? ON ACCOUNT OF.fl7';;~-/ i F >'~'~':",,-h?-iI -r . /:/I/J- cO? $ ~u. c.:'D c=./h-z,/' .....::.~::, /" !20 ) DOLLARS 100 ,-,:/' ,......, "" '1..,...., " " , ...::;.....c...; ,.,. p,;.r::O:'...,..".,J. PAYMENT TYPE III AMOUNT CASI-I CHECK\~r1~M'O ...., . E.F.T C.C.fB.C , OTHER ..;;;;;;:.:.:~...~,--".,.C"".,/~;,~. ,-0 .-.- ,,-7 ~.<.. --~-'''''''''''''''' .,.~/ \ ~,;'/' ~ . AUTHciRIZED ~IGlRATUR~ ,...." .-' " -