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REFUND AUTHOR�ZATION <br /> T0: City Treasurer Date Co-.�� • 03 <br /> You are hereby authorized to refund ttie following: <br /> PAYEE: ��0�����T`� <br /> ADDRESS: ��/o� GrG��oC_- - <br /> �d.¢ae'�5� /J.9 �'i.�at33 <br /> AMOUNT: $ /�7 SO / <br /> REASON: ��/�u7���]oitc-E-(�il/f'� `f� D�P/1� �e O3�S - � 3 D <br /> /�-�n SP.v�2-� rt✓f u:�r'� -C�Ip��/ --- <br /> CUSTOMER ,/ <br /> ACCOUNT # ,SP QTTaC-LP� <br /> This amount was received by the City of Everett on 3 '/O - 03 and recorded on <br /> (d�[el <br /> permit or receipt number /�inZC�Z - D/� <br /> ,�p3c73 � O�/�/ <br /> x o303 - oo�v <br /> t __ <br /> vL <br /> Idec�l IAuthonz�d Sipn�mnl . <br /> /'��/�'l ��r' /Jc�-�-��/�i � '(�� <br /> mu.i � <br /> Refund by Check No. Date __ <br /> _ Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy <br /> � <br />