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everett <br />�e�� <br />REVIN D AUTHORIZATION <br />To: City Treasurer <br />Date <br />You are hereby authorized to refund the following: <br />Payee: 101nr nn Consfr, <br />Address: <br />. f30X <br />E✓cr: if <br />lyl. Zip <br />iB'o3 <br />/.mount: <br />na <br />$ <br />V <br />�f art <br />Customer <br />DUZ <br />-Z3733oODOU ( <br />fnr Fe o� <br />Account No. <br />S-2 <br />This amount was received by the City of Everett on 5- lc 19� <br />and recorded on City Treasurer's Receipt No. <br />/SC has bee returne cancelled. <br />❑ City t�'�i>ts Permit No. <br />❑ Plane have been returned to this department. <br />❑ A charge has been made to the customer's account for this refund. <br />De a Authorized Signature <br />Title <br />---------------------------------- - --------------- --- <br />Refund by Check No. Date 19_ Original Receipt <br />Attached <br />Account Debited: Fund Basub Elem Util Obi <br />or <br />Refund Noted on <br />Treasurer's <br />Office Copy <br />