Refund Slip - Municipality Of Anchorage
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1MUNICIPALITY OF ANCHORAGE
Finance Department P.O. Box 196650 Anchorage, AK 99519-6650
REFUND SLIP
Customer Name:
Date:
(Print Last, First, Middle Initial)
Type of Refund:
(Check One)
Cash
Credit card
Check
Other__________
Reason for refund:
Customer Signature:
Customer signature is required for all refunds.
Please send refund check to:
Address:
City:
State:
Zip Code:
Telephone Number:
Departmental Use Only
Date of Original Transaction:
Transaction Number:
Refund approved for:
$
Cash Receipt Number:
Dept/Div Approval
Date:
Account
Fund
Dept ID
Program
SubClass
BY
Project/Grant ID
MUNICIPAL FORM # 40-026 Rev. 06/08
DISTRIBUTION:
Original - Treasury
Photo Copy - Department
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Parent category: Business