Laserfiche WebLink
<br />CTTY OF SANTA ANA <br />Customer Account #VG27572-USOO <br /> <br />Mail us a refund check. <br /> <br />Provide the following information about the individual who will receive <br />the check: <br /> <br />Name: <br /> <br />l\ddress: <br /> <br />Phone: <br /> <br />Our records indicate we have no claim against IIewlett- <br />Packard Company for this amount. <br /> <br />/' <br /> <br />Company <br />Name: <br /> <br />(:1 Tt OF SANTA ANA <br /> <br />~- Q~~/,{7a~ <br /> <br />Authorized <br />Signature: <br /> <br />Printed Name: <br />Phune: <br /> <br />nA '71 n N REAM. r TTV MANAC::RR <br /> <br />Ti tle, C- I -r '( . fVl ftlJ A &-t< r? <br />Date, --.1)/lf!,. I" <br /> <br />A TrEST ~ <br /> <br /> <br />....- '. J!'J <br />/ //} - . <br />Lr~-,...'" <br />PATRICfA-jL r;EADr <br />CLERK OF 'rUE COUNCIL <br /> <br />APPRO '" , I,:; TO FORM <br /> <br />,;y&'; uu,;j,'.P v'0' <br />v L:,.".",..,y <br />ASSJSW,H i...dly Attorney <br />