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tU;;NI!R"'L. FORM NQ. 3'2 ~RE.;V, 11...."
form PI"Elscribed by Stote Boa:d 01 .JS,,-cl:OUnIB Boyer:! Focma Sys.tems. Muncie. In.
U RECEIPT (. )
DEPARTMENT OF COMMUNITY SERVi'CES
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2465
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FUND
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RECEIVED FROM,.( U;J~cLJ-7lrl}) L~~ti:~ $ /,;>t-
TH E SUM OF . ~'7./-.-J~>{Hf;,~;r?i7 cui'- Y-d",/"",C" DOLLARS
/ .' v '" 100
ON ACCOUNT OF f}!-U3SP JM{~F~~/~/"t>')/;L4
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PAYMENT TyPE: & AMOUNT I
CASH CHECECX /r't;t!:?J M.O.
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OTHER
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