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� <br />everett l <br />REFUND AUTHORIZATION <br />To: City Treasurer <br />Date _ �� �� 7 <br />You are hereby authorized to refund [he following: <br />Payee: �� �.4N (ISiQ�/yi�d� <br />Address: . ' <br />Amaunt: $ �Q, QQ <br />' Deacription: �,/� / <br />Customer <br />Account No, <br />This emo�+nt was received by the City of Everett on Q'/ � lg� <br />aad recorded on,City Treasurer's Receipt No.- �.— <br />�. �oG 9.� <br />L( City,�UlE'.� permit No, do�d has been <br />�1lcancelled. <br />U Plane have been zetumed to this department. <br />�� A charge has been made to tt�e customer'y account for this refund. <br />�' 3 a <br />Date <br />------------------------ <br />� <br />32139 Au�rized Signature <br />_�9<�� .�� <br />Title — <br />------------------------------------- <br />Refund by Check No. %��-% Date <br />� - �_i9 71 <br />Account Debited: F�u/n�d� Basub Elem Util Obj <br />�T' U' j ���' L�J �.�� ,�� <br />� ,-, l_J_t_. � �:_: <br />� <br />Original Receipt <br />Atta�hed <br />or � <br />,,Refund Noted on <br />�� Treasurer's <br />Office Copy <br />0 <br />