HomeMy WebLinkAboutReceipt IV VI•IV. vy uw V
Carmel, IN 46032 p 317.571.2417
GENERAL FORM NO 352 (REV. 1007)
Prescribed by State Board of Accounts. Boyce Forms Sy., Muncie. In.
RECEIPT II
DEPARTMENT OF COMMUNITY SERVICES
N® 2706
(al FUND
CARMEL IN., 9fsAf 20 0.3 RECEIVED FROM t`7l)l 7. 0-0
THE SUM OF �LG'! C. /1'1 LY
ti../.0
6) DOLLARS 100
ON ACCOUNT OF 1J j„ �0f 0 3 e 'Cc000 -1
0
PAYMENT TYPE 8 AMOUNT
GASH. CHECK
0) 9 M.O y
..i
E.F.T. C.C./B.C. OTHER_ N
At7TH0 RIZEO SIGNATURE