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Form .PraG-cr~~d;bv SIa.te- Boaidto: Acco~,U Boyce F-orms SY~!em:'l'. MWlme. 'In
RECEIPT
DEPARTMENT OF COMMUNJTY SERVICES
!J;i.,.,EAAL .rORM MO. :!II'IZ 'toll:\,. r ~!J"J
c;tD~~_
N'~
2014
FUND
CARMEL IN.. ~1 L- II 200d.
RECEIVED FROM Ern r-\.cL \ $ 9 @a.~_
THE SUM OF ~iN>r ~<-'~.K:> E'~~ '\-.-D ~~OLLARS
ON ACCOUNT OF S -G.;l '\)I? ~'fY\~~ _ ~LS ~~~
l D~l2--0 . D .. .
PAYMENT TYPE 1.1: AMOUNT .----. ~ \ l:!"Ql<.....~'-- ~
CASH CHECK ll{- d~9 '} M.O.
E.F.T.
c.c./a.c.
OTHER