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t"'.. ^ ~~.~ ~,...-: ~-_..,...;.-.;....,...,. ..~... ~,:J..'r:;"-~;-.-,.,.."",. ~-r. .-.....~-,.7. '.:.;".-_'_....,.:=-_~__.-___.'w;, '... .'.-.-.-- ~...--..,.. ,_......_..,-,~ ",w._~: ..-',- ~-' .c-' "- .-...., ~~-'._-' Form Proscribed by Sta.te Board or Accounts Boycl';'.' '13 Systems. Munde. In. '-. . .' U . . RECEIPT" '. ..............-"'-"'"..-.-,.................',.....-........ ~ - ~!_,._ ___,.,,"~, .;..,,_.....0<.',.-...."....... . . u -QIiNE:RAL FORM NO. 3!:J-:il (REV. 19"'7!" DEPARTMENT OF'COMMUNITY SERVICES N~ 2469 J/ d LZ, ;;{" '-fil'P ,../ \.;7"'-'..... <I---""~ 'F"~.,. CARMELIN.-. FLJND /. ~:.', i - . ,0', " i . ~~~.. v. ~ "'i ..--, 20('/ 0 -"j ...., ,- , ,.~..>.~::.~;(.-..-(~~ /, If'(...' / /. I 't" -:. '$ ./ U I /,,,>/'{j .RECEIVED' FROM THE.SUM I j ,<.(./',,::. ,~;:<.,..._,.r ,.( <I / '". '_.'-"!... '~""; !.:..i- -I - ". .c.... '" ...... .'A'.tff /. F /,' 1"--/ ' :.J,,~,"<A::/-&(." . .~. '".~' ,,>". :.~' "........" '..__~-'- L-" '.".." t/ ;/ .~ - OF i~:"':C/ ;-!---;1",4 ..' \ ,.J " '0:' .-c-:;1.'-.~ r:.-C-;.:,/...:::;..1:J.?.,.:.,_____.,,__ .' (-4"v,,'.-...,~&l.~'L-.:ft(_....'" X(./J,-,:./...Lx/!o-'-..! . ( . ,,'" :~ . --'D~Or::LA'R5~--.. ON AcCOUNT 4 . I f? //'J;"'.i-';\LC;{ .. '- " //.:5>~! "7/ 100 'PAYMEN'T TYPE 8: AMOUNT . . ./;':1 f ~J .~ ~:;~. ./ ._....,~i...o f ! CH~9~o'~.".-- ''',k~..'''' , . : / c.:::---,A -~!. /? /...... . ,". OF " ......... '! -' /f .~I.- .:::. 1...../ -. /1 ::2,'. :.~~- -. {) . ./ /:,";/ .1 / C. C o:;;:J ~:;;;:"J....",J", . _'/'1/','" .,~~:::;.-j'i.. _'~'(::~::"':/'> CASH M.O. . \. ,...-",e:!J.!~-,~i,p'-"'-";C~4....-<,;'c~" AUTHORI~~ED S1~N~TU~E .E.F;T. c.c1s:C .O.THEFt