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Print Form <br /> } <br /> REFUND AUTHORIZATION <br /> Please Complete Authorization and forward to Accounting for Payment Processing. <br /> You are hereby authorized to refund the following: <br /> PAYEE NAME: <br /> ADDRESS: <br /> AMOUNT: $ <br /> REASON: <br /> CUSTOMER ACCT NUMBER: <br /> This amount was received by the City of Everett on <br /> And recorded on Treasurer's Receipt Number: <br /> Debit Account Number <br /> AUTHORIZED BY DATE <br /> FUND MANAGER <br />