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everett <br />REFUND AUTtiUR; ZATION <br />To: City Treasurer Date / �.p <br />You are hereby authorized to refund the following: <br />Payee: �ld� /�i�/JiJ?�GrS�� <br />Addresa: ��-3� ���`,���� <br />.��/'-�-?T �9 Zip � <br />. �' -zs <br />Amount: $ �d <br />Reason: � <br />�.F�viouS �`���/7 C�i�l"c f��� ,,U c o F <br />Q7f/�GE Gc�v�PiE' /%EbC��-�4//I�G'' �'?< SJ <br />Cuatomer ��/T /7v,�F: C� nlo co�PT_ <br />Account No, <br />Thie amount vae received by the Ciry o: Evezett on �.+? 19� <br />and recorded on Cicy Treaaurer's Receipt Nu. �� �_. . <br />❑ City Permit No. hae been teturned/cancelled. <br />❑ Plans have been returned to thia department. <br />❑ A charge has baen made to the cuscomer's accounc for thia r�fund. <br />�i <br />/ Dat <br />------�-----------------------'----'--".."--- <br />� - � �� <br />� uthorize 1 ature <br />j�llLiY'C/C �S"c�f'!/jCcc—S /%,G'.� <br />Title <br />----------'-'--.."`----------'-^--------- <br />Refund by Check No. Date 19_ <br />Account Debited: Fund Basub Elem Util Obj <br />� i , , , <br />� <br />�L! , � W <br />�� � � � , , � <br />or <br />Oti.ginal Receipt <br />Attached <br />Refund Noted on <br />Treasurer's <br />Office Copy <br />