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Form Pr6ecrIbed by Stote Board of Acco\Qts Boyce Fonna ::iysterml, .MunCIe. l.n
, RECEIPT . .
YPARTMENT OF COMMUNITY SERV~S
ClRNI,(A:.6.L FORM MO. ,,:12. IRE..... Igo;,)
GiI)e7'al
N:~
2467
FUND
RECEIVED FROM
THE SUM OF
CARMEL IN.. /-30 20 r0-
c: ,d-t t! .~~e/-7!u.;.J $ jl c2; e.f?..
/1 L . -' Y6"D/~-
.~ ~'1..-~~'e:~~:Lr- .;{"'c, -"~~OLLARS
,/ V 100
ON ACCOUNT OF C' he'
PAYMENT TYPE 8< AMOUNT
CASH CHECJ<'X/J/3'6%'/ M.O.
E.F.T c.c.fs.c, OTHER
/?- 0 ~ S)CJ ,-4' /i, \.,' ..//21 ....,.L.... .
c.~-'"V ~t:..-_.;/L-~'" ~r
='-~~b?~
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