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<br />~~ <br /> <br />.'ATlO' 'LORlDA <br /> <br />O. c City of Zephyrhills <br />I <br />. PASCO COUNTY <br /> <br />877.50+ <br />1,?78.00+ <br />350.0(1+ <br />330.00+ <br />34.84+ <br /> <br />EMENT REQUEST. REFUND~ISCELLANEOUS PAYMENTS <br /> <br />005 <br /> <br />.l1-{2- 9f <br />DAT <br /> <br />2,870.345 <br />100.00- <br />10.00- <br /> <br />007 <br /> <br />FROM: <br /> <br />& '_ ~ <br />~- <br /> <br />2,760.34T <br /> <br />. ~CX /) j1 <br />AMOUNT: y ~J tfo o. - <br />PAYABLE TO: , C!.L~ q!~) (~;;t;:;/~. <br />a? 77ft, d:J LrdR~ r7f ~ <br /> <br />~ <br /> <br />cJ -'f~;",t~ F'I- ~ J t; 1/1 .' <br /> <br />VENDOR II: .. 6 . <br />.' 9~ <br />/C) ./'") ~ O>"Q ~ -1:1.1 ~ 0 <br />REASON FOR PAYMENT: q';l..<VnL .erJ ~~ ~ s1~) ~~ <br />cy 6..J a:tiiv (]9h1/llL<i:OdhJ ~-u.6) .2. 't.J ar4v f'lldiE..., 6f tUlrm ~$ r <br />,!~3S "IOO.l21l.?~!S 7?~J--u-. ~:) . <br />1;1:55 'f /O'~ In. ddmPn~OM(!u5C!?Yf1"'-G?d~jI:zq2- <br /> <br />CHARGE TO ACCOUNT II OI-3:;'~-OOO P#Aml?6 ~?~ 4:-'0 <br />6!)/h CX'12~~' --- '11- '3'13-.$"50 ~EIVRl <to !,2~' l?2 <br />'~Ury' fJ- L(I- ~1g-$oo /VA/Me.. .a5b,d <br />~ ~. . I '1/- ,jJ/g~ ~O ( /AJ/l7r.R.:::f 3~O ~;C?:-~) bl <br />~ 9JJC , . o..~ () 1- ~g() -. 00::1. ""f{'E'auESTED if: _ Q-~ .. '11.1>... _ <br />V pvl' , 0 q-W- ~.Ign.'ur~ . <br />(~. APPROVED BY: \ _ ~ ~ <br />J (Slgn.lure) <br />ACCOUNTING USE ONLY: <br />Paid Oat. : <br /> <br />check . <br />