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• • . e. <br /> f'VP.YC'�f ' <br /> /� �'. RJiFUNU AU:fIORIZATIO� <br /> \ �J <br /> ��f./ • <br /> To: CiCy Treasurer Date / -z ��� <br /> T— <br /> You are hcrcUy auChorized Co refund thc following; <br /> Payce: ��i ,��i���n .�`-rj+_.L� <br /> / � <br /> AddxeSS: n (� �C> ��C'i_- _ �l,c�5,�- <br /> TT <br /> Amount: ,�1.�� <br /> Description: �n����-,� �,2.�� � i��.�c'c�- _ �' -��� <br /> / !'.0 �'-e- �`;-�-.-1 /���Zi�/`- �� L/�/z(f,�G7'�',I�.:C.,�G <br /> (� <br /> CU S COIllL'Y , L � <br /> Account No. �7 A y �i 7 / �1___ <br /> � � <br /> This amount was received by the CiCy of L•'verett on 'f�� 19��� <br /> and recorded on City Treasurer's Receipt No. �? d'7 / . <br /> � . <br /> (� Cit'y Permit ido. _ has been returned/cancelled. <br /> U Plans havc been returned co this departmene. <br /> �� A charge has bcen made to the customer's account for this retund. <br /> � %' �/:(U`t2-s�L!' (.=, �//-1 .lK,, .,� <br /> Dal�-- Authorized Si�naturc <br /> Title � <br /> ---------------------------------------------------------------------------------------------------- <br /> Refund by Clieck No. Ual-e ,19_ Original Receipt <br /> Attaclicd <br /> Account DcUiCed: Fund BasuU Elem Util Ob,j <br /> . � �� �yi �u...� ��� �or <br /> 2Letund Noted on <br /> `y�-� �-'�-' —' L"'- ``" Treasurcr' s <br /> Ofticc Copy <br />