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Form Prescribed by Stale Board of Accounts Boyce F"...... Systems. MUDCle. In
U RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
GENERAL PORM NO. 3111 tRay. IDg11
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2128
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FUND
CARMEL IN..
erO
$ /'I/(1 7i/iJ
THE SUM OF
ON ACCOUNT OF
,
PAYMENT TYPE So AMOUNT /
CASH c./6.".'l57~.o.
E.F.T.
c.c./a.c.
OTHER