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~, . Form Pi'ucc,ibed by Stole EOllid 01 Accounts Boyce ForU'tems.. M~cie. In. -. RECEIPT ~". (J FUND CARMEL IN., y.' \ OJ 20~ RECEIVED FROM Wi8. "~- ~~G;;~ti~b'<=L~, ~cS..C-- ~ ,\ <:3= .~~~ ~~-,~ ~D~ ON ACCOUNT OF ~'" !4-o'~ ---ru~~'hL~A~TS V c- ( ~ <-0 '~--=+- PAYME:NT TYPE & AMOUNT . :;-i' ... CASH~_ CHECI< O('Ill 1'01.0. \ C.c.fS.C. a~~L--' DEPARTMENT OF COMMUNITY SERVICES THE SUM OF E.F.T. /1 ~~L,)' . ~~OF!IZE'O SIGNATURE' OTHER - GE.""~RAL rQ1'lM NO, !O~~ 1ft:::\'. IS5Itl N'~ 2031 $ J~. C8-:ib DOLLARS 100