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HomeMy WebLinkAboutReceipts Form Prescribed by State Board of ACC:OU.""I.t9 Boyce -Fo.rms Systems, Mi.illcla. In. W RECEIPT DEPARTMENT OF CqMMUNITY ~\:71 ~ '\.J SERVI CES ~I;;N'E:RAL FORM NO. :3~2 lRE". tB'9071 N~ 2187 -,<tJe:~l1z<'. Lf- Fu ND C).., . ~6 "1 -, CARMEL IN;, /~~ .::;-..," 20 (.t;..~ :::-~(;:r;('~ ''-'T~;;:' I;:' /' ~ RECEIVED FROM" l'?/ ~/\.'J'-f~..A:~ '''''~/1/J . 1/ /. //rY ~ ..""',' THE SUM OF "-..6'4/ /~....-,,~IZ)-;, (--..",c...r:/ ...{;;cfi // .....~.:/ . '\ ':~-:-'. .~L "/'-<;'/ ON ACCOUNT OF~:;~;Z~~L-;Le_Y~-"o.~- V '1/ -c .' .., l v:/~ .' a"J)' c-.~../ ,- l .'~".- c..Q . 7../' .;P'...,...,;:; -J ,-" ..-- vi / PA YMENT TYPE lk AMOUNl ~. '--." / ~. '" /' -~ .~.~-y ../ "-' i/ \. . ~ ....--- X' ;;::.'""}tl{/n' CHECK'. '7 -!' .' , M.O. $ b~:30 00 .'~ (.:~ C::'./~... ;;'::--- .I'''''!''' /, :-""":90LLARS 100 CASH '~-~::'::.'~~;-=~7-'.'-t:-<:;:~~.:~:;t/ I)~--'~.. ,,--..._..,_-.r'~ AUiHoRI.zeo .-5tC.NATWRE~ E.F..T~ c,c.{s.c" oTHER Form PrllserihEJd by Stole Board of Acco'linhl Boyee Forma Systanu. MUI.de; Il:1. ClCHt:1'tAt. FORM NO. 3~~ {flel/. 1 go!)?) U RECEIPT '1 '\ DF~ARTMENT OF COMMUNITY SERVIC~~ N~ 2 1 71 1'/ cA~~-J!__._~ THE SUM OF ON ACCOUNT OF FUND /' ~,.~~, CARMEL IN~#-'~r/5 20{.25\ '// V)' ,_" , { .. ,. /", ...'.....;":. / i/' . RECEIVED FROM-K~~c"A'~~<.-~.j ./~6'-.fl1...C__y;?;-,\ ',.,,,,.. it'. <_/~~., v::-;:-:: '1_ . /' .",~""...,r {-- '-r:,J"-':&''''<<7.e.-"..-Q n "Z-t.,(? /VI'..xl~,,-,_,( i.~":i;:,,,.....ft,>,,,~.,. " . -~ ~ ' ~ {>t~~/~'" ~-- "'-1~. t:::F;J )4cO ,/ $ {f'i' ~~o? 6-:06 "9'(;74" / ~OLLARS '00 PAYMENT TYPE /l:.AMOUNT \/ "5''i...;c, /' CASH CHECI<)/l . E.F.T. c.c,/a.c OTHER , J ,.'""~..-..."~-._. '-, ~-..... (''''...........,._,.. ",;";"J .<~___ -'-~--"~""'>-,~ -" "-,,,.,._~,,~.~ ..'" .... .. .--~~~'~ g , .I,,~/ ;-,/. AUTHORIZED 91d"NATURE I_~' M.O, l{i(;~iGial Che6( :;;;: . , - - ".,.'., ~ .. ,The'HGnti~~t6n :N~;ti()lJaIB~nk ::;; ." Columbus, Ohio' 43219.' " )~:':,-:\ '>',;t::;"Hua ';1 ,i~'n,!,:,t7,: Order Of ....... " ..., .f'~;i1~]1~~~i~~'~;P~~~h'''' I ISSUED BY: MONEYGRAM PAYMEN-j-;syi:m~~s,;INC,::;';( ." ",,' . ""'CO: c'::P,O, BOX'9476, MINNEAPOlJS,MN.55480 . . DRAWEE: "B0STON'S.I\FEDEPOSIT,,&'.:TRUST CO, . ."., :: ,': BOSTON, M~~Stc;H.uSETTS; , ,'/ Ilg ~ 0 2 u... 3 ~ 7 ? 7111 I: 0 ~ ~. 0 0 70 '1 2': 0 . bOO . 0 b 2 .. ,I.. j 711g