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: .;.... ;O:~~~b~'S:n;~~~d'Of~:~I~~OOO:'~:=:~:~:'~"""";'"........; .'. ,qU" . RECEIPT DEPARTMENT OF COMMUNITY SERVICES ; -;: .; 'r.:' .'. ~,. ; : : ..NERAL PORM NO. 3152 (REY. 18e7) .~ FUND CARMEL IN.. 0 .... C;?O 200-z-. RECEIVED FROM /~~ V~~~ II;)./! $.35U~7.) all /J . S/ THE SUM OF ~ ~~-- OOl:LARS ON ACCOUNT OF . g 7 -.0 2.41),l.~ ~~-.. 100 .~r t~ j~ ~~~ <" /tJ~~' . PAYMENT TYPE Ilr AM~UNY/ . ~.e.. .4-t4~ V 5.2()t:fI.~q / it> ~; --4 V ~.H CHEC- - ....0 ~ ~~ ~F.T C.C~B.C OTHER AUTHORIZED 51 ATURE Ng 2132 :"#""'" '.. ... .... ,- ,- ..... -., ,--- -,,-- ,., , '. .. . ~. .-'. -' . ,... \