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':, 'FQrz:n .~ie8citbed-~Y.::'~tate'.'Bo~rd.-~f 'Acmiu,ntB BoY'~e~F~tms:~tem8~- MUUClfl.-.1D,..~ , .-' . <.,', ,R'ECEIPT,,' ,j'" . ~EPARTMENT ':,OF:COMMUNITY SERs.rd:S :41-EH'''~''t.. 'OAM"NO; ~'isz lR~'J.'la~71. N2 2'5.00 (3;",;.~t;;~".,,:> /' ',PUND CARMEL IN~. .::"7'::;,, //.;/ '20i0 RECEIVED FROM 'THE' SUM OF O;:.(,~.".,~. k~';~'c: /., ,. ,:r..':' " . ) "l/-::;;<"'~ .;;. (.,,_ ,-;;,;;:;::':-t::=--,~ t:.:, ~ ..... ,',.- -"--", ~,-: ;;,) $ j~~;;:- J~ ---- . ..,,";:::i~j,,,~,_,: ("~.. c.-,,~_:( ~-2'.:t;p~:':. # r! - .-, ~-":"-' , "i':':~'.,:'" ....~~"'".:....:.~.;.:~...".. /':::0' DOLLARS ICO - . ...(~;" ." ,.. ON ACCOUNT OF /)f""l--<< {).3 ,.!)4.,::;' . -?7, . ~-:~,.~ ~___~...:C;"""~ PAYMENT TypE a AMOUNT ~ CASH CHEC~~" .;'~'C. M.O. l,.:::':=-;':':;:'~:.':"'.~~.~~.. ..~...<~,'''' '..... ';;r/~1::: ""'~"''''. ". E.F.T C.C./B.C. OTHER ...f' (,..~_......I AUTHd'RIZEO~JSIGNATURE "\ 1/)