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Fonn PreBctWed by State ,Board of A~c:oun!s Boyce lorm6 Syg'ems, M,unoe. In
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olJENJ':F1AL :FOR-'" NO. :1-01 (REV. IOIHi
RECEIPT
DEPARTMENT OF COMMUNITY SERVICES
C1~ FUND
CARMEL IN.. ~,,1 ::') 2d2il~
RECEIVED FROM -,~~ ~~"'~~
THE SUM OF-\.,.1fI~ .(..,,,,~z'D r.Fl~ ~
,
ON ACCOUNT OF -59 -C>d-- hr:::,L S ~,'\A ~G
?A""'NT TT?" AMa"NT '"ft,~,u. n~ ~&"'"
CASH _ cHECK 9 J~6 M.O.
N\2 2041
$21'50.00
DOLLARS
100
E.F.T
c.c.{a.c.
OTHER.