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y �V �C',."�Ci � <br /> � �� � RJiCUND AU1'lIORI'I.ATI�Y � <br /> � --- <br /> � °, i <br /> ' ,� �f'� . <br /> �i . .CAn <br /> �To: Ci[y Trc�bucer Datc ��" 7 ^ I 3 <br /> You arc hcrebo authorized [o reL���d thc 1.'ollowin�;: <br /> Payee: _�uG �Cf�/LE � <br /> Address: `j �^ �_�/ F, ; <br /> . a <br /> • .��R ys��___r�r��'_�_ (.i�,�__�7 0 <br /> O = <br /> Amount: Y� . � <br /> Uescription: SEe-.1�2 Y-E/21/T � 0203��J'� <br /> iUoT T1Ec�.'�b� KE .�� (ZEPAr2s .r/'or Req'D� i <br /> , <br /> Custumcr ' <br /> Account No. �._. , � <br /> This amour�;: was ceceived by the City of L•'vcrett on �`T � 197�j I <br /> J <br /> j <br /> and recorded on City Trensurer's Receipt No. <br /> I� c�t �038� � I <br /> Y 5 WF Permit No, has been returned cancelled. <br /> U Plans have bcen returned i this dc�artment. <br /> �J A charge has been mude to the custo r's account Lor this refund, <br /> �d - � � 3-- _�;ctiU/l I' �� � � <br /> pate Authorized Si m ure ' <br /> �'ii�—L��,i,��=__�iUG,�, <br /> i�ci� � <br /> -----------------------------•---------------------------------------------- <br /> Refund by Check tio. ����%J Date '� <br /> —t ' ��� "� ��19 ��3 �riginal Receipt <br /> Attached � <br /> Account Debited; Pund IIasub Elem Util Obj <br /> . '� ���� Ji; 4.�,_�.: �D.d, or <br /> �,� ,_,y , ePund Noted on <br /> —. _�_ ��. /� <br /> y Treasurer's <br /> Office Copy � <br /> I <br /> I <br /> � I <br />