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N~ 2541 1 ",',1, "1 ";1 Form Prescrrced by State BOC1[d of Accounts Boyce F.~ms Svstem,e. ]J.Liinde. In. ~~- U ' RECEIPT, ..W "DEPARTMENT OF COMMUNITY SERVICES /dK)!0-4~.f " GIS:NERAI.. I"Ofl;M NO. 3!U. O~I::V. 199011' FUND .-.;: -"7 ~ ::r / 20 u_3 -....,-L~--; ~--./' f(:?, "-.~i RECEIVED FROM c.?<.tLu:.,(..Ic /'A4'PAA!<~f THE SUM OF c::-~~,pc{~~i.u..Li4'./~~~'c~;:;~'/~<' CARMEL IN.. ,.j .i';~.;:)~V7i:IJ /' . ,'.'~ {/ . --/,.., , ',1 ;;=:~L#J:5:(.e,...!.cyji/t.;(-t/(:..i1I'-,e, --0-0 C!:1lI"R"S/ . 100 c!'7~ '7-":::: _, . ..'- r-:: ~ $, .' I.,..... -1 " ~- ~..,.. "/'. ON ACCOUNT OF J'1--05. /:/7'1 C '/"'/ ,.....' ",1 ,,>kA/uZ,<.,.L../ .--,' (>'" r~:~ . () _;;~ /:.1 r,. / <:::' /' J h -,' l-..-::, c' ../<i .~J ~ PAYMENT TYPE IX AMOUNT .1'" .~ A~;:jt/4 . / "J.....-"J.~ .,>'':: / ,'/ ., / C. '/1/ .-', I.' CASH CHECK ~, ,/ ( M',a. ;~~<L-x..-7~~_... .c....c/ ./ ,,'." of ,,~>.r.:.::~,..-~<~.,.(....<I,../_~!1 AU'TH ORIZE9:->SIG NA TUc.'5E E.F.T. 'OTHER