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\~ \ 'Form Prescribsd by' Stats Boa.rd of Accounts: Boyce.Form9 Syst-c~, Mcncfe. In;. ,. . . U . . 'RECEIPT U DEPARTMENT OF COMMUNITY SERVICES GENERAL F<JRM NO. ~Hj;O: tREY. 1$901' ,..,-~ ~f"',---=:-:", (r" // --c----...,.., , ~ j.~; ..--o.Ob~A R S '00 N~ ~." C~:>Je ,4./ -4-FUND /- ~~;}r' CARMt;~ IN." .' . . ~~',< . . . .c:.::"::.',:'~" . '~ . '-/..-- RECEIVED FRO~7'?i',,(.~ugC{C.;'iQ:,.....?1"A<O/~''--' ~c. ,;"'.,~)~, ,p.u<~, -' - . ..-, .. r) '1" .~t:./' . /'. /' ..".f ~ ""v ''--..,,,~--,,"''''~;(-<~' ,'/~I..A:::.A~.~_J ,~.!'.,-,.<ji.--:.;"-./' ,po........... , (/ t.' 'ONAGCOUNT OF /L;'!" CJ..3 ~ ))/.:>' A/11~~2C( . t;")":::~ .20_ THE:' SUM :Of ,/ PAYMENT ~YPE 110 AMOUNT '..-'J IT-, /....::"",....$.:::;,..';'"7, CASH C~ECKYO I ;-7-'\;{o"'':'" /7'" " \ . :~FII3'S. ' ~,::., '.~ ,-" ..: c.--.....:::;;,,- '..---.~.~~.../ .~.. .'. ~ :....k .' ------,---,,~j......... I' . . . .....-<~..-:-#': ">j-z.~" _ ,..J_:. /". '. '. .... ~~,... .-At;-H~RI~~~ ~~~.N1~~~~- . '_:. ., E;F;-;T " :OTI:!E~, "".1',: -" ,; ~,'~-.'-'" 2463 I)V 36 ,K!-"O- >-~ -:i: ~