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� <br />`�1■�f1 <br />T0: City Treasurer <br />!G3 30 - �,/��%��e C� <br />REFUND AiJTHORiZATiON <br />You are hereby authorized to refund the following: <br />PAYEE: <br />ADDRESS: <br />AMOUNT: S <br />South Point Assisted Living <br />3823 Kromer Ave <br />Everett WA 98201 <br />105.00 <br />(Ted Harchenko) <br />Date 4/1/96 <br />REASO N: 5.0. and fee not required to install me[er on existing service <br />dotm2nt for less [han a vear. <br />CUSTOMER <br />ACCOUNT # 401-343-4G--!!9-471-02 <br />This amount was received by the City of Everett on 3/2s/46 and recorded on <br />permit or receipt number s.o. 8s55 ������ <br />4/1/96 <br />(deul <br />Refund by Check No. <br />_ Original Receipt Attached <br />Account Debited: <br />Or refund noted on Treasurer's Office Copy <br />Date <br />(Authorized 5(pneture) <br />Buildine Official <br />fTiNal <br />