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i <br /> i <br />, <br />� ',��-P,`,`,�F_ <br /> - �. .�• �� ;i:�� <br /> , e. <br /> �`,�,�,-;�, <br /> y'::Y.:,� <br /> S��'.;;t, <br /> ;�,� <br /> REFUND AUTHORIZATION � �'` '� � <br /> .:.,u,;. <br /> .�4 <br /> � ��y 1��: <br /> . -���''F�� <br /> �')P� <br /> T0: City Treasurer Date �;'°'' <br /> You are hereby auth rized to refund t following:, <br /> PAYEE: � 1_di'� � I/IA ��"D <br /> ADDRESS: _ ��O J� /��n��f . �,� �'� <br /> _ �'�����, /� J�4 ��ZD`3 <br /> AMOUNT: S �, 9Z <br /> REASON: <br /> 7 <br /> CUSTOMER 7�Ze�� �Z�Q� . <br /> ACCOUNT # . <br /> • This amount was received by the City of Everett on _ �D ��j�-9 � and recorded on <br /> ��� `� (datel <br /> permit or receipt number <br /> _ ,�/�-97 <br /> (detel (Authorized Sipneturs) <br /> �oV- /,l/Y�'i %i�/il J/OQ(/�l�Ucz( <br /> Rtlel <br /> Refund by Check No. Date <br /> _ Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy <br />