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Farm PrEacIi.bed by State Board of AccoUnb:l Boyce Forms Syotems. MundeT In.
I ~ . RECEIPT
~EPARTMENT OF COMMUNITY SERV\dS
OW;Ne:RAI.. F(;;\flll'. r.o.. 3:!.'l:;l; CnC;v, I!:lQ,.,
d~
FUND
CARMEL IN.. / -~;( i 20 O'IS
~~I J /J _ i ----r--
RECEIVED FROM ~ /?:t?~&.u'/'_____'8..-/
/} ~
THE SUM OF "Jvf ~d,:t~"'--------
100
ON ACCOUNT OF 1/ -r;2. () 7-D 7
PAY.MENTmEOAMou:4,,1j} ~ ~~ ~~
CASH CHE 0 di- M.O.. ~ t '
E;.F.T. C.C./S.C OTHER AUTHO. 0 SIr.. URE
N'~
2462
/2 .~
$ k~.:) (J/5t1
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