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GENERAL- FORM NO. 3!f2. (REV. 19971
RECEIPT . .~
UoEPARTMENT OF COMMUNITY SE~ES
~ FUND
CARMEL IN.. &/t z, 20QL
RECEIVED FROM ~ /4 ~ ~~k~lA...-: L fJ
THE SUM OF '-~~, .Rv'U~(a-' xt.-Zltr i--{~-
ON ACCOUNT OF . t g -0 '2- .s-P
P.,MENT TYPE' AMOUNT ~ ~~ II OJesfd'ir
CASN CNECK3Qg,3 M.O. . ~
E.F.T . C.C./S.C. OTHER AUTHORIZED NATURE
N'~ 2 11 2
$560 ~..?-
UOLLJ1.RS
100
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