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,~"" ':... ." ,,'t, .", '.. .." ~, ~ . .',' - ",..:,. ,.." "", ,', :'~"'''''P"'''''''-''''''- .',_ - ..j, ,,_, ". .... ,....,.,_..".~. F_ PresCribed by State Board 01 Ac:aoUD18 BOY{~Jms Systems, MUDcie. I'RECEIPT U DEPARTMENT OF COMMUNITY SERVICES .~":"~L~D~M"N~. ~~~. tR~Y. I:.~: - -,j 1 ! N2 2081 ~ FUND CARMEL IN..~ -.;< '3 20 oZ- , RECEIVED FROM ~ E' J . s.3.C;O~ "'7/ ~ ' ~ ~~--_.__._-----.g.r., LARS a: t/,'/-I 100 """'""---- ON ACCOUNT OF ?~-O2- /!/)L.5 ~~ '-"h &~ j ~ ~ ' PAYMENT TYPE a AMOUN~ . ~.~'-1:....<__~ CASH cl,{c'r~5',f6 M.O (~.;(_.<.;..u~~ ~F.T. c.c./s.c OTHER AUTHORI~ SIGNA E THE SUM OF