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Form Prescribed by State Board of Accounts Boyce Forms System.. Muncie. In.
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CARMEL IN..
PAYMENT TYPE III AMOUNT
CASH )( CHECK
E.F.T
C.C./B.C.
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL FORM NO. 352 (REV. ID87)
N! 2181
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$c?\ tJ'
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. _ ( DOLLARS .1...
100 .
M.O
. RECEIPT .
~J DEPARTMENT OF COMMUNITY SERVICES
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CARMEL IN.; 7/A3 2d?.Z
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RECEIVED F,ROM
THE SUM OF
ON ACCOUNT OF
PAYMENT TYPE III AMOUNT
CASH CHECK/15)
E.F.T.
C.C./B.C.
N!
2182
McfO ~.
/V () $
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DOLLARS
M.O.
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AUTHORIZEO SIG&RE
OTHER