Laserfiche WebLink
everett <br />REFUND AUTHORIZATION <br />S-2 <br />To: City Treasurer <br />Date .S /9— 95- <br />You are hereby authorized to refund the following: <br />Payee: _(� o. c%., A. C <br />Address: C�er Av <br />✓� e 7� Z ip 1�?2O/ <br />Amount: S 77 S/Soo pO <br />Reason: <br />;$'ti'cc� 2„0� of ey /morcv�in�.,ts <br />Customer <br />Account No. <br />This amount was <br />received by the <br />City of <br />Everett <br />on <br />2 — /`/ <br />19� <br />and recorded on <br />City Treasurer's <br />Receipt <br />No. / <br />12JI <br />/ <br />�%>u6L: ", <br />El City c�o�f r Permit No. 4 116-5 has been eturned cancelled. <br />❑ Plana have been returned to this department. <br />❑ A charge has been made to the customer's account for this refund. <br />Date ' Authorized Signature <br />Title <br />Refund by Check No. Date 19_ Original Receipt <br />Account Debited; Fund Rasub Blem Util Obj Attached <br />1 i or <br />u� Refund Noted on <br />Treasurer's <br />Office Copy <br />