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;,,;.-,....;(.'~:,: -~ -.-:" -.:;..;;~ I " ~_ ' ,_',. c. ... _.. .~ ; \. Form Proscl'ibed by Stot" Btllard ot A~C:OUntB BoycA':-'"1I.rms Systems, Muncie. In. . , V . RECEIPT U DEPARTMENT OF COMMUNITY SERVICES I H ,'j ...,. /-~. P'" -"' .,'-""'C/t.('J!.-A _4 , FUND CARMEL IN.. ....7 /7" ..-) ,~ - 20/) e.::::, RECEIVED FROM /l;::':~ ,t1;;;:~':'v::'r..~ , ~1 / / THE SUM OF",,,>:~-",''-''7 ,-'kf,h.-.J,,( AI", ON ACCOUNT OF '2.L~? "l.' :.; 7 "I;;~;', ..;r;; ;!.-9 ,,':J j .._.-;.-f"/. /-;/ '" .r".j ,"A.,;'~,( ~?f //A/_.....,..~;'#..., /~ _,/.....tf~f.l/~..!:. ~:1"./ ~~ . .. - - - -- . ---..... ,::-J ::;. ;;: . /) 2, "7 ~. t""....~,.oW' PAYMENT TYPE 8: AMOUNT //" ,~/(///.-:'.Z~."", ,,// ..'7 /f ~;.~ /. CASH C:~ECI<" .:> /A r>:;.' M.a. /~;'/'A~ :t~; ) ./....,1 ,',/," " ..'/9--',d E.F.T. C.C.fB.C OTHER QiIi/'lllER"'L FORM p./o. 1~:Z ~R;EV. lQ97J 1 , ,:1 ,I N~ 2537 :,'~ 1 ~ ,1'--1;.'~" $ ~7 -'it ::: "..~i:'_~.; <--'-;, ~ .:;,.... .. , .....<. ':""''''<:'fclJ3el::b.-AR5-_m~'' 100 ;".,- "I ! :i '1 :'j 'I ',] "