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• � <br />T0: City Treasurer <br />t� <br />REFUND AUTHORIZATION <br />You are hereby authorized to refund the follnwing: <br />Pi�YEE: _/Jlan �o , ��o e�fn � � . . '1� <br />ADDRESS: <br />AMOUNT: <br />RE,4SON: <br />�I'_. , i �/ , <br />Date _ /Z-//-9� <br />CUSTOMER ` <br />ACCOUNT # Qa2 -329 -iZa6 aaa <br />This amount was received by tFie City of Everett on /Z-�-9� and recorded on <br />(dete) <br />permit or receipt number G�/�.�% <br />(date) <br />Refund by Check No. <br />_ Origin2l Receipt Attacheu <br />Account Debited: <br />Or refund noted on Treasurer's Office Copy <br />Date <br />(Authorizad Sipnature) <br />(Tide) <br />