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everett THE EVERGREEN <br />cm oF <br />'_` ever�� <br />� %% CItt M�ll • EVEPEII <br />.� W�SMINGION 9lI0� <br />RFFUND AUTHORIZATION <br />To: City Treasurer <br />Date: 7 ' � Z� � j � <br />Tou are hcrrby authorized to refund [he following: <br />Payee: � � L1�.:..-r.� <br />� � s`' Y <br />Addresc: 3 3/ % ���-'rc" (l � .wC.v.-L <br />Amoun[� S �S�r� �1�yJ� ,����J/ <br />Dc�cr;ptinn �,n"��C� /� �� � /2 �" �i ''� /'�C:iz , <br />/� � .t:.c�� �����«('. <br />A✓..', �%. r'� ��.�, �,.c c% �.`�: ,..�� <br />Cus tomer -i,- —, <br />�---= -�a-��—r�ti'-�— > `��-=5-1 �!-c,s 3•>-� <br />Account No. —ia �v� <br />3/: -.-� � 4. � <br />T�-�i: amount was received by the City of Lverett oc '�/ 19_. <br />�vS"G ✓ <br />._ .iy <br />:�nd recorded on City Treasurer's Receipt t{o.,.��� �� <br />� City Permit No. has been returned/cancelled. <br />� Plans have been returned to this depar:ment. <br />LJ A charge has been made to the customer's account for this refund. <br />J 'L z.� 7 <br />D te <br />Refund by Cluc <br />Account Debited: <br />l5. �o <br />50.00 <br />;�_ , �J% Date <br />Fund Basub <br />po� 3N/ <br />e�z 3`1l <br />/ `v <br />.��/� i ( �/ �^� <br />Authorized Signature <br />��� �' �. <br />. - Z, �„ � — <br />Tit� <br />- :�.�- i9 96 -- <br />Elem Util Obj <br />31 <br />38 <br />Original Receipt <br />Attached <br />or <br />Refund noted on <br />Treasurer's Office <br />Copy <br />c <br />