Laserfiche WebLink
_ <br />� a <br />e <br />w <br />D R- 462 <br />Revised B-21-75 _ ~ <br />(Sec. -19.5.106, F..S.) <br />REQUISITION FOR REFUND FROM COUNTY TREASURY <br />STATE OF FLORIDA <br />COUNTY OF Indian River <br />Pursuant to Section 195.106, Florida Statutes, <br />1025 Flamevine Lane <br />OJohn S. Shernan. Jr., Tr. of P. 0. Box 2138, Vero Beach, F1. 32960 <br />ayee esi ence <br />Hereby makes application to the Department of Revenue <br />for refund of $128.46 of moneys paid.to the <br />County, and as grounds therefor sets up the following facts: <br />(State reason for Refund) <br />Attached hereto is addit <br />claim, as follows: <br />d Sworn and subscribed to <br />before me this a(-.'`'tday <br />Of 19-2AL <br />Notary Public <br />(Payee)9f Floridi at large <br />My Ce-n:n''xio E:p:rac Oct. R. 1930 <br />i..N� 8. AMI IM I- t C.—U, L* v -v <br />c;?o-.j <br />o� 36 PAGr 342- <br />OCT <br />42OCT 41978 <br />