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- - - <br />=i;' ;�,,wi. <br />.J, . rN <br />_�i.3: <br />•:t,�•••�K� <br />';tii�����'� <br />I <br />To: City Treasurer <br />,�' :'J 2 � r�:%u��� �� Cti� <br />REFUND AUTHORIZATION <br />You are hereby authori•zed to refund the following: <br />Payee: �,J�Jl1 .%. �['�7///fJ,l./�ct�i <br />Address: Q�/ `S��) � �S� <br />�.��J�,�� , /� A z�P Oa ' <br />U a t e---��-�� --L�L— <br />Amount � /20°� <br />Reason: D//�yy�l.I� „x,.�. lAl/1� ,,�',Q.�,rll,!`n%O��/,LrtLCIJ)'YeC� <br />L[LeC' �lY�2P�( J .li� °�� � ,L//IUiL/.GlICL�L" (ILU�/%� <br />Cu s t om e r �� •�1�i O-�i ,CCL�IZC�2cL,.,�,,.,�e1'2, ���llLllG�iLLQ�,�/�,Gju <br />Account No. lJ/12-.�9�Lh /1/IQ.9l �� a��'�` ����aL`-5' � <br />This amount was r ce�by e C,ity of L•verett on� .� .319 <br />and recorded on " . o. �%%�90 9� <br />L'7 City �1�1L Permit No./y�39�9/has been returned/cancelled, _- <br />❑ Plans have been returned.to this department. <br />❑ A charge has been made to,the cus omer's ac:.ount for this refund. <br />� ��� _ � �� <br />Date Aut orize Signature <br />Building Official <br />Tit e <br />---------------------------------------------------------------------------------- <br />Refund by Check No. Date 19 Original Receipt <br />Attache; <br />Account Debited: Fund Basub Elem Util Obj <br />or <br />Refund Noted <br />, on Treasurer's <br />Office :.opy <br />