HomeMy WebLinkAboutRR_-_2900_Idaho Docusign Envelope ID:9042B526-99EC-41AO-B6F5-043423AOD889
PUBLIC WORKS SANITATION DEPARTMENT
REFUND REQUEST GARBAGE/YARD WASTE
Name: L r ' Ll�l ,, ,[ S Date: ✓�����
Address: V\ L R ii2� Phone:"[`
City/State/Zip: ��#I(
Service Address:—gel o 0
Refund Amount Requested: $ ��- z5 **Documentation Included: Yes No
**All request for refunds required proof of payment before refunds are processed.
Comments: asta" E'At qa l,-bct l t se rVt cts
but V10 , 6+�4 card on JO( LS-es
Signature/Sanitation Department DateFaT�
Confirmed Refund Amount: $ S3 2; Confirmed w/Water Works: /Yes No
Signed by:
; twood 4/21/2025
In�W&%Rffure Date
Refund Amount Paid:$ $53 . 25