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N Q V 71973 <br />eeor� � PACE Ion <br />D R- 462 <br />Approved for Refund in <br />Revised 12-16-70 <br />the amount of $ <br />(Sec. 195.106, F.S.) <br />this Day of <br />, 19 <br />Chairman, Board of County <br />Commissioners <br />REQUISITION FOR REFUND <br />FROM COUNTY TREASURY <br />STATE OF FLORIDA <br />COUNTY OF DADE <br />Pursuant to Section 195.106, Florida Statutes, <br />Joe H. Burton, Executor of the <br />830 North Rrome Avenue <br />Estate of JgE L- BIRITON <br />of Hnrnpate4d, El. 11030 <br />ayee <br />R si ence <br />Hereby makes application to <br />the Board of County Commissioners <br />for refund of 107_71 pd,.s <br />of moneys paid to the <br />interest <br />County, and as grounds therefor <br />sets up the following facts: <br />(State reason for Refund) <br />See Summary Judgment attached <br />qY <br />and Tax Sale Certificates 261 <br />of 19682 262 of 1968, 263 of <br />1968 and 262 of 1968 <br />F,L A UVED <br />Attached hereto is <br />add i <br />t claim, as follows: <br />DAT !2 <br />Sworn and subscri d to <br />before me this day <br />DEPARTMENT NUE <br />of October Q 19 3 <br />Notary Public <br />oq gy ig �drT <br />,�� • � ; ,y <br />a <br />N Q V 71973 <br />eeor� � PACE Ion <br />