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.; � F <br /> i. . <br /> REFUND AUTHORIZATION <br /> T0: City Treasurer Date <br /> You are hereby authoriz�d to refund the rollowing: <br /> PAYEE: ,�P�O� <br /> ADDRESS: ��O �J� �!'',.�.�K�� � — <br /> �✓e� c�.lc, q3'zo3 <br /> AMOUNT: S I ��� ,_ <br /> REASON: r.OwtP�{P� iinp✓m��"►?P.+'r�T c.�.�..'�(n 4,'�� �0 �aZ inS�cil(�, •� <br /> CUSTOMER , <br /> A(;COUNT # <br /> This amount was received by the City of Everett on �� q� and recorded on <br /> • � taeco� <br /> permit or receipt number �2-���4' . <br /> 1 ?i S �� • WLF'��� . <br /> (� (Authodzed Slpnatuje) � <br /> � �.� Te�',Gr �'� - <br /> (fitle) • <br /> Refund by Check No. Date <br /> Original Receipt Attached <br /> Account Debited: <br /> Or refund noted un Treasurer's Office Copy <br />