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For'" ProBcribed by Stnte Bawd of Aocount. BoUr",. ~Y.l~'. fJluncle. 10.
RECEIPT
Q.. ~~c>'L.-..
CARMEL IN"
RECElVED FROM
THE SUM OF
ON ACCOUNT OF
PAYMENT TYPE & AMOUNT
CASH
CHEC.. ~)
c.C./s.c.
E.F.T.
u
G~~EI'I"'L FORM NO. 3!t'- l~EV. \g-~1~
DEPARTMENT Of COMMUNITY SERVICES
FUND
3-&0 26Q.~
Le La P-;~ L\ f'!r.' ~
~~~ A1r"~ ~i?'>
~~
'Q~Y
~.a-.-;e, G.Lr""E- '\==> A-P--.><i!-... ~~ I
}
,d,r,.-Obt S p
M.D. ~
OTHER
N~
1982
$1-ia0,6U
--eDLLARS
100