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Form PresC"ribed bv Stelte lIo-Q1'd of AccoUnt" .scrce Forma Sysieml. 'Muncie-. [no U . RECEIPT /-: . DEPARTMENT OF COMMUNITY SERYES A-VVAJ CARMEL IN.. RECEIVED FROM THE SUM OF ON ACCOUNT OF PAYMENT TYPE Be AMOUNT !e, q 8.0/ CHEC~ 6 CASH E.F.T. c.c.{a.c ',... ~i' 'U::H!:RAL FORM ~O, .H51 l!=tf:.v. 1 ;'97~ 'N2 FUND 2123 20_ -I 1_ r<;:' /).,' J --r.-7l CO) ,..-=---;r-; -- fJ I - C u ..-'LJ--'Y ;. ,,-:~A.{.4r'1~./"/?'1-- ~l-' ~ ~r'l. \-----1t. ' $ C~,..5 c)--_... j) '. fd d,.1 [,v---_. _.~'...A.-l A--tA/n. >V/1 ~t( ?"{'/ (!<?..-_._~~..~ . DOLLARS S' U 11- 9/ .-'- 0 Z lac ~ /) <:.:::~- 0 1 r} ~::~: jj"-'.Cc.,::...,;" :;;rt c;Ae....", t-t fJ1J..f! _.lX--- -c.> ,"- .J M.O. ,'/::;T-}/,f,7 i ' I /j /ll...~/l-?-./A~~/. AUTHORLZ;E;:O 5lGNrffuFlE {.i OTHEP