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everett <br /> REFUND AUTHORIZATION <br /> Le - <br /> To: City Treasurer Date <br /> You are hereby authorized to refund the following : <br /> Payee: 5 ,lt Ct 14/ is <br /> Address : 237 t�2m \,9 . <br /> L-tt 60,4 zip "0 <br /> Amount $ 7 20 <br /> Reason: <br /> Customer <br /> Account Ni. /T/}roling� <br /> This amount was received by the Cit Everett on—%-I/- 7/f-? 19_ <br /> and recorded on Citrl- -� .i,t No. Ct,�03Q3 <br /> f-City Permit No.C'073e)3 has been returned/cancelled. <br /> ❑ Plans have been returned to this department. <br /> ❑ A charge has been made to ,the cus om is account for this refund. <br /> Date ut orlz ed Signature <br /> Building Official <br /> Title <br /> •-------------------------- -------- ------------------------------------------------ <br /> Refund by Check No. _Date 19 Original Receipt <br /> Attached <br /> Account Debited : Fund Basub Elem Util Obj <br /> or <br /> Refund Noted <br /> on Treasurer' s <br /> Office Copy <br />