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� everen . <br /> REFUN'i AUTFtORIZATION <br /> To: Cicy Treasurer Ua[e � _'.9— y>' <br /> You ere hereby authorized to refund the folloving: <br /> Payee: J O v�"� ,co:ei <br /> Address: `�/" _ ����,� ��c <br /> — _ _- — .� Z ip ��7--'=" � <br /> Amoun[: $ <br /> ��pG�'�, <br /> Reason: :Ui_=a�/'.�.T4�VC•- ba��%.•�V�'li% <br /> j.E -C;-r:r,�-". T,n.�.-'v..E�+EvT,j <br /> 9� 2'.�G' - �I'riG.C�.@ ��%;. <br /> Customer <br /> Account No. <br /> This amount vas received by the City of Everett on �_'—�<� 19 0�� <br /> and recor.ded on City Treasurer's Receipt No. s'j�8�� <br /> �.���d�.c <br /> � City �'v��^eJ Permit No. . 7- h''� has been returned cancelled. <br /> ❑ Plans have been returned to thia department. <br /> ❑ A charge has been made to the cuscomet's account for thia refund, <br /> 7 _ �q- .g� �-�C,.'-c�� <br /> Dace Authorized Sig¢ature <br /> ,� • 1. iv <br /> '-LY'. s--l'�. <br /> Title <br /> ---------------------'---'---'-'---'-'----------'---'------------------'---'-----'--------------"- <br /> Refund by Check No. Date 19_ Original Receipt <br /> Attached <br /> Accounc Debi[ed: Fund Basub �lem Util ObJ <br /> or <br /> � � ' W � ' W <br /> Refund Noted on <br /> � � � ' <br /> . ' • '�J `yJ Treasurer's <br /> ' Office Copy <br />