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.. <br /> �I O REFUND AUTHORIZATION <br /> � <br /> T0: City Treast7fer Date � � <br /> � <br /> You are hereby authortzed to refund the following: <br /> PAYEE: �r��iL1��1tI /r1 / --- <br /> ADDRESS: /�'� �,�' 3G� _ <br /> .,l Ltk'� �f � CJ/ <br /> AMOUNT: S �(J(�•� <br /> REASON: � ��;� ���1,�- ��n ��1, f�yinc�� <br /> - u� )20i- 1 2 <br /> �- — � <br /> CUSTOMER <br /> ,accouruT � 40/39�-90/�'/-97/-GZ <br /> This amount was received by the City of Everett on l�-��Z and recorded on <br /> (d�nl <br /> permit or receipt numher �l [l�Z -L'J2,f� <br /> �� -2:�-G� _ ` .. <br /> Idnd Uutharix�d Sipn�mr�) <br /> ��.J.�c�u �.Gl,c�l � <br /> . <br /> Refund by Check No. Oate <br /> _ Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy <br /> l � <br />