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� � <br /> REFUND AUTHORIZATION � <br /> i <br /> T0: CityTreasurer Date �-_� -c%� I <br /> You are hereby authorized to refund the following: �I <br /> PAYE�: (-j UGti1oL(Grti.S-PC Lt!'� ��l I <br /> ADDRESS: _ �O Qo�( �7loG� �I <br /> _.��PQT�/2 /�)fI r-l'�o��' � 7C�Co <br /> AMOUNT: S �o�. Sv <br /> REASON: ( "� J� _>�,� ,(� . -�z)r' O[/�z� /.r�rlouti � �,c� I, <br /> i <br /> CUSTOMER � <br /> ACCOUNT # r� -��a -iavo - �3 � i <br /> This amount was received by the City of Everett on -� - L�� and recorded or. i <br /> te.�e� � <br /> permit or receipt number .C, Dc�U�- OOv'�- <br /> . a <br /> � <br /> � <br /> �3 -oa ��-� � '� <br /> (daql b I <br /> (Aut�orixed Sipn�tun) <br /> ,���, � /��._ <br /> md.i <br /> Refund 6y Checic No. Date <br /> _ Original Receipt Ar�aci;ed <br /> Account Debited: <br /> Or re`und noted on Treasurer's Orice Copy <br /> I <br /> � <br />