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. "" "., ''-, I, ' ; I '", ... ~ _".._,_'.._' '-- , , ' ():" " ' hlln Pre.e,tbed by Stall Doard 01 ^"eounl. Doyce Form:! S}___" Muncte, In, , "RECEXPT DEPARTMENT OF COMMUNITY SERVICES "U. ' , , Qlli:l'ofSflAL )l"ORM NO. .!I~'i' CFH:V. 199:r) ,~;j~~-( N2 2135 FUND CARMEL IN.. ,_ G ',,-~; (2002- ,,....... ..-;' ,...--; .. t.l ".~' '",~-' Z-ru / ,; ,f7 c,'-Q RECEIVED FROM /';U4'r~YFL./C-"" -,C.i: >'V..A~ U1,,"~./L- $/,;{;( {)/tiJ >t: 0./ /J'';;' 0' THE, SUM OF ///L{' ;ti~~.~7:.a4L,du;/,:.:zu//0 ~--f)eLLAR5 <""" j .~;.. 'r"'; / tI 100 ON 'ACCOUNT OF ~ (.'(_./tJO-02.... ,I ~-30.'- '- E.F.T. c.c./s.c OTHER :;;t / ._. o-V , b30. ./) - -1 Of (~;J.71~-"-' \~~k,;.......~~;::~l AUTHOFlIZE:tJ Sl.'fNATURV . OUN// V /j'il/ r? PAYMENT TYPE Ii AM~ ':S' '5ot . .7 ru' (.~ CASH CHEC1"'.-" - <;I () M.O. -;", .' :~