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~ .. . ;a~~~~ bySlale BO~d ~~caunIQ Fa~ S~l~~. Muucle: In. .", u ., ."N'BRAL PORM NO. 3!Sa (REV. ,aD7) RECEIPT DEPARTMENT OF COMMUNITY SERVICES N2 2078 .~ FUND c: - '73 0' z. .-" C?i '20_ .. {,?frfy~ ~;~ ~~~jf/6;r'----'- , 1t;; -0:2. /1 DL.S // t/ (/ , tJ";JI ~g~O;hi:J CARMEL IN.. RECEIVED FROM THE SUM OF ON ACCOUNT OF --....- D6LLARS 100 -. /') ( 'f ....--1/)/ ~ PAYMENT TYPE 1Io AMOUNT /' _.' /",i{.47~a-,.-;-'- / /<-:2;71/ ,tl CASH CHk~. ./ -- I M.O E.F.T c.c./a.c . OTHEP \/l,." ~-'''''' A.AI b" j " ',.-"....~"1- ,~'f-A'."..-.;~ /21' ,,/ /fr V, // Y '"Q. \./~ C.A~ ~ ,,-a---X., =::/ AUTHORI%'i9"'SIGN liRE ) I \\,