Free 45882.pdf - Indiana

RECORD OF RECEIPT OF ACCOUNTABLE DOCUMENTS
State Form 45882 (R2/2-08)

PEN Products Plainfield Correctional Facility 757 Moon Road Plainfield, Indiana 46168 (317) 838.7129 fax: (317) 838.5865

Forms Distribution Center
TO:
The _________________________________________________ County Department of Child Services.

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I hereby acknowledge receiving a supply of official Department of Child Services prescribed receipts with beginning and ending consecutive numbers indicated below: Beginning number Ending number Check one: State Form 37 37A FS3

Signature of sending agency employee Typed or printed name Title

Date signed

Signature of receiving agency employee Typed or printed name Title

Date signed

Indiana Department of Correction

V-336-R/2-08