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Form Proscribed by State Board of Accounts Boyce FOSystems. Muncie. InRECEIPT U
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FORM NO. 3~2 (REV. 19071
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2184
FUND
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RECEIVED FROM ,,~J~./ /i1_L LLC
THE SUM OF J~~~
ON ACCOUNT OF id>-02., /r~
mM'NTT'" &AMOUNT / ~~ Ifi~ . .
CASH CH,~_5t<5 M.O. ~~~
E.F.T C.C./S.C. OTHER AUTHORIZED GNATU
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nnl LARS
100