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"9 1 <br />everett <br />� / <br />� <br />REFUND AUTFIORIZATION <br />To: City Treasurer <br />You are hereby authorized to refund the following: <br />Payee: <br />Address: <br />A.nount <br />Reason: <br />Boston Chicken <br />Date 1-17-95 <br />PO Box 4086 <br />Golden CO Zip 80401 <br />$ 200.00 <br />Credit amount due from refunding one water service <br />and applying portion to another larger serv3ce. <br />Customer <br />Account No. 401-3434011947102 <br />This amount was received by the City of Everett on 12-4 19 ?5 <br />and recorded on City Treasurer's Receipt No. <br />5.0. !1's <br />❑ City Permit No.gz7g,go has been returned/canceiled. <br />❑ Plans have been returned.to this department. <br />❑ A charge has heen made to the customer's ac�ount for this refund. <br />1-17-95 <br />Date <br />`�'I i�t,P�,� -�'{--ti.. �� <br />Aut orize�5ignature <br />Building Official <br />Tit e <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 />