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- ,,-cribed by State Board of;Ao""""... Boyo" Forma Systems; Muncie, II>, U RECEIPT U DEPARTMENT OF COMMUNITY SERVICES G~N:e:;frA1. F'OFl'''4 NQ. 31:12 IIII~V. I "U7~ _&.4A'/:JA AJl FUND N~ 2573 CARMEL IN., "';~"d- I 2o/J3 <--h ... . '-'~/}d- , -7 /' C-:;~ R~CEIVED FROM //(..e>i.t.~...e;~~_~.... .I...?/f/A_-<Z..L=L~ _. $ / t::XJ 1~:,7J ./, , / . /-,L L' TH E SUM 0 F .-4u .4R'~-f ,->;f.,~-d~.#~x:.2t'.--;r;~--:I -~.e~~7-:'---'--C)b1::-bMs.___ .. - //1 ,I.'f -. t/ / I 10<>_ ON ACCOUNT OF 0:::- 'Z)3 /-1l:")L. S ' (/ " PAYMENT TYPE S. AMOUZT, ! ,- , r"/) CASH ~ CI<: t_,") 006(.M,O .. - ~ . .._'-- - ~ -. ----___h.'._..._ /1 j , :;J , , i -{ I J ] E.F.T. C.C./B.C OTHER //~-;i\_. .,.,=-;::" . / C_.-'r~J.5r" )~~"'!.":..-G-C--' :"~..L."~--.~.-y'::d.r~-/ . .~ ~ ,;\UTHOIH2::ED srCiNATURi! . /"/ ,:,... ~I