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[ r"""~i;C;:S::;'J;'l~:Y;;~1i~V~;:t;:~)i::~!Zii~~;;~"'~'iM~'''O' DEPARTMENT 'OF COMMUNITY SERVICES ".~LU-J FUND :"F'<'::':<:rW,~c,;?:'\C!Y. ~)ry:',~"F')1';:;';:r"i',,~,"'.:'; '''"".-,:,,<l '. ._~""... ...,,""'~' ,m" '\ N~ 19'96 } 1 I J RECEIVED FROM THE SUM OF "':7 ,/") ..r- ...."""'l .~) . o{ ',I', /. I - - 20~ "r::;~, ',' //},[' ,) / L ,? / ..-, ''j-~ ..."--,J.r.::9-'~<J..e,A...-/ ;:.M., ~l?A.,.~ h l,_ "'J ~J ,u- ",_/l .,_ n~' ..' 'f~ $'..[."-- .IC"'f..,/V f," ,; " '/' , ".-' ' j~~' t?tl~U~--u7~ ~~~~'./._----"---~-~.._- .. " ,..' c' _, ,/1 DOt"L-ARS , C / I ~ /l"1 /'1 --J ,/'/" :./ '-';;lI,f c.., ,:/100 ON ACCOUNT OF ,~ td 0<' ~ .. u ..-<:-- ~=~~,.t:46t.~-:f .A;,~P/-;1'"24~ ,/ r CARMEL IN.. '~ ,I ,I '1 I 1\ 1 j PAYMENT TYPE 8:'AMOUf'}!"/' , V' III//} CASH CHECK . ( , ~M.O. E.F.T. C.C,/B.C. OTHER // ," /;/ ~ (~~~__ ~/p~"~.4 1'1 V AUTHORIZED S'~NA.TURE ./'7 /;...~ v' - ' " .... ..,.,-'-'-