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Form Pre.scrwed' by ~tate Hoard ot Accounts J:l:oyee ,t'OIma bY':J~ern.s. MunClC. 10 lJIlNE"FlA-L FORr.r ,",0, 5lJ2. .RE..... 1~911 -, . .' RECEIPT - - U .,/ \ . -.- DEPARTMENT OF COMMUNITY SE'MIICES .IUiQ r't;!. 2053 4~~ RECEIVED FROM THE SUM OF FUND ~ /;0 20 b z.- ( - . 7!L~~u-/c. itl4'utM~ .sj~fI~,vl -ct:i, . /Y) / / / J~. - I ~ cv/tf r~Ui.A[A . 't..f Y- /h-- DOLLARS [, 100, ON ACCOUNT OF . .~r;, - 0;< AbL S f!-11LL-I1i.C[ - .J2.lM-Li-. S~~ V [() ~ 0 -2-- "- ~(~() 2. I~)k{~ J..~ PAYM[;;NT TYPE a. AMOUNT ::;; 0 . CASH CHECK OO!I ;?1 ~.O. ~A--i~____~ 7 I OTH~R AUTHOR,ZEO S&URE. E.F.T. C.C. B.C. ~ CARMEL IN., ~- $ !{)0. 0 J