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GEIURAL FORM NO, !S2 IRH. 1907\
form p,."<:rUle<l by 51111.. lloCll"d 01 AC<:<lWIlI Elf ",FOI"" Systems. Muncla. In
V RECEIPT ()
DEPARTMENT OF COMMUNITY SERVICES
_fi~
,fUND
"Zr (2-eJ 200 2--
RECEIVED FROM ~ y:: ~~
THE SUM OF ~ I~,wd ~~y ,A;""y-
ON ACCOUNT OF v- (5 -02. ;J-4~
CARMEL IN.,
PAYMENT TYPE 13< AMOUNT
M.O.
L5f~A ~"O .,"",,"",
CASH
CHECK If 61 0
C.C.1.B.C.
OTHER
'5:f':.T,
N~ 1944
$636~
DOLLARS
100