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� <br />� ev�►ett <br />�pUND AUTIiURIZATION <br />�AT <br />Date � ��-87 <br />To; Clty Tteasurer <br />you �re hereby authorised to refund the fulla+ing: �� �UB,6 <br />Yayen: <br />�//CO.t/ S�/G - <br />pddress: <br />.30 /- //6 t� dE. S, E. Su� rE /2� <br />BEGLEdaE W'9• — Zip 9B�vs� <br />00 <br />�moune: c 200� — <br />Reason: <br />E.f`a.PM9•✓CE �-n.� .?fl.c�7EF � <br />/�OA6� j ST.YE�'T j",P?odEr�EtiTs <br />Custamer <br />Account No. <br />�hi,o amount wa� recnived by the City of Everett on <br />7 ,3 8G 19� <br />and recordad on City Tre�eurer's Receip <br />t No. 80350 <br />��,e,[s pezmit No.BS-31o5 ha� been ret�rned/cancnllad. <br />❑ City � — <br />❑ Plana hava bese ratureed ta thi• department. <br />to tl+e cueeomer'a accouat for ehis rafund. <br />❑ A ehacge ha� bann mrde <br />�� <br />/ _?(o - 87 i <br />/Author Signature <br />D�te / <br />�r/����, � oi� /%%% <br />Title ______ <br />----^----- <br />---'-'--- <br />----"'--'------"---'-' _ <br />_��y__ Origlnal ReceipC <br />Refund by Check No. Gate Attached <br />Account De6lted: <br />Pund B�aub Elem Util Obj <br />i �y � �"' <br />i , � � � � W <br />or <br />Refund tioted on <br />Treasurer'• <br />Offlce CoPY <br />