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"c:. :"Fo,.i.Pre.i.';ib~d'bt Sl.<ite ild&d.i,1 A~~oiint. :B~y:e~For~;Sys'teiri'.;M~n",,,:h:.'" ' I..... , . RECE:IPT" . ;.-, U(iEPARTMENT OF COMMUNITY SE~CES _CHERAL: FORM !'tC. :Jilt iFl~v.' 1&111:17' ',N! 2 1'91 G~/Jf"'""r'~ I FUND CARMEL IN.. ___/(~.J 4./ ...:::2"1" 200';::\ ot:;'-.~ /. // ' RECEIVED FROMe /..-,~~.tl_~~~{:;-c:~/ ~4;7l~>~~:::7",,,,v' u """) . . L~~.'<-_'/<<""" " />, >"" ~ ,'/ ?",:;r: / _.~~===- THE SUM OF ,'0;0 "c,c. ~', '..c",_.,;;;.. ".~.;,.)( ,~// ~ .9 /1- (.;2 -.....~~c ON ACCOUNT OF ./:/1/' l..t:-O -.te--1~ l .....--.- I '" .::;~:? $ ".' c/ ~,,~. - /} z;. DOLLARS PAYMENT TYPE a AMOUNT CASH CHEcK:V /~! X'i-;;,JIif::~ E.F.T c.c.{s.c OTHER ~------~~ . .' . ......,______,~..", ,'_--"". ,.1/ ,.rI-"~",,~ _-::t.r,":'''~''''_~~''''''''''';''--'I/ / "" .1/' /./ AUTHORIZED $[G-"NATURE ~~~ V '\ ."