HomeMy WebLinkAboutMS 01-14; TABATA RANCH; Engineering ApplicationS
CITY OF CARLSBAD
(j) REQUEST FOR REFUND
Account No. aJLs7io 4"( I i Vendor No.
Amount of Refuncf/)7/â4O Fee Paid For: 14
Date Fee Paid: iO/Z5/O1 Fee Paid By:
Facts Supporting Request: A7 ivi ct\ ot-
Name of Applicant: Nnhnru Phata
Address: P.0. ox 679, Car1ba, C 92018 760-754-1900
Street City State Zip Telephone
Signature of Applicant: Date ______________________
Dept. Justification:
Rec:
Approve 0 Disapprove Date
Finance Investigation:
Rec:
0 Approve LI Disapprove Dept. Head Signature Date I
City Manager's Action:
0 Approve 0 Disapprove City Manager Signature Date EM
M'b OI-I Lf'
City of Carlsbad
1635 Faraday Avenue Carlsbad CA 92008
Receipt
Applicant: MR AND MRS NOBURU TABATA
Description Amount
MS010014 2,514.28
Not valid unless validated by Cash Register
PLEASE RETAIN RECEIPT FOR REFUNDS OR ADJUSTMENTS
Receipt Number: R0023768
Tiansaction Date: 10/25/2001
Pay Type Method Description Amount
Payment Check 147 2,514.28
Transaction Amount: 2,514.28
3143 .10/25/01 0002 01 02
COP 3.1.428