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HomeMy WebLinkAboutReceipt ~ez ,IRE.... RE'CEIPT DEPARTMENT OF COMMUNITY SERVICES N~ 2158 . "r: ;/ f....... '\ i/'C' '" \:".;.i~':~.",~, ::".,~. .. .O}f.r.l_..)":',~,I." ' 20~ I ;;) $ (:~_:I t~:~ I, :1 :, I: II: ii' I' II 6~,~ )<:~'~'_" f~:'. "-n~l /' ,\.,..~ '",. .,..... FUND ,,,",-, ,t.t.-,(" ',"";';: CARMEL IN:.'''' ' -I-;"--~~'/ '.,. " ,..;~ ,~ ( RECEIVED FROM" ~/ c~.~,~\ :: i :1' i i' ' \11 : I Ii I THE SUM OF ~~:::~'"'. ./: r;:....~,...;? .r (~. (.:,.;.~~~~:, ,,~., "- ""}/.; 0,' J rjllt'~--~~ (.......;...-!.J" (i: t"'t.(AI~ '; ",.~""".... C<,p' """C,'" ~~.t"", I" - ...,-\'()O DOLLARS ON ACCOUNT o'f!:1.""-" '/,"l ~"~-_'--:/J" ;i.~ '1'i~~. 01.'-;~'" (. d, .....' _0,./ ;(' "'."./ ,-, " ~ (;..4'" ...,..' :..'-N ~ r ' "..- ....' '''~ Y , ... '" ""1 <:../ 1/:" 1,'"',',,.:;.,,:, ' - J.....{.>;.~'~."'.~:~,~.i,..._ . ;>' .....- ... - {,,~,':~\~:~, ", .' l"'!..'}~ ~~'~~~.' "." 'i:.:'; :/" pAYMENT TypE !Io AMOUNT, " X CASH CHECK M,O. <0..:..';;';:, ._;:.i"I~--;t/'ioo,.JK, ~~:;;;.;,~t~~~, .,~<:, ''':'. i .:......'.'.- AUTHORrtEO SIGNATURE: l>.F,T C.C.(B.C. OTHER Form Prescribed by Stat; Board 6f Acoounts Boyce Forms ~ysteml'Jl Mui:1cie. ~n. GUliNERAl.. FORM NO. 3:1;1, ~l\E:\i, \997f