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� <br />�, <br />T0: City Treasurer <br />You are hereby authorized to <br />PAYEE: <br />ADDRESS: <br />AMOUNT: <br />REASON: <br />REFUND AUTHORIZATION <br />the fotlowing: <br />/h��5 �%c�(2o>^� <br />�J-�.a %� G✓/� 9��03 <br />Date � �i ;�,_ <br />CUSTOMER <br />ACCOUNT # DOa.. 3L�9 �/O/ f�40 <br />This amount was received by the City of Everett on �f-G -�/'� and recorded on <br />� ���3 / fdete) <br />permit or receipt number � <br />� <br />i <br />�G-9� - <br />(dete) <br />Refund by Check No. <br />_ Original Receip± Attached <br />Account Debited: <br />Or refund noted on Treasurer's C�ffice Copy <br />Date <br />(Titl�) <br />