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HUMBOLDT COUNTY, NEVADA adjo Tax Refund CertificationNoucher sjonlR Televj
-
This section to be completed I the person(s) reQuesting refund
Pay To:
Za7ez
Address:
J/I
)14aisc44J
Ai)
Fia”S A/fl±f V4 c’A, *N
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V Quinn River Television District
9 9%
U
Assessor’s Parcel # 4Y3V-c 1-37e’ -a
Humboldt Television Department 500-000-52010 709-000-52020 710-000-52010
Denio Television District
S153
Physical Address:
lP/e certify that the television tax paid on the tax roll for the above parcel is incorrect because: Q”TWS parcel cannot be served by television/radio signals of the television district/department U There is not and will not be a television/radio receiver on this property during this tax year C The correct number of television/radio receivers for this property should be__________________ C Other Under pains and penalties of perjury, a felony, llwe swear that the above is hue and correct.
r
6/777
‘
3tgnathreofReftmdClsimantoat’ This section to be completed by Board at Cowdy Co.nmlnlanen
This satan to be ceaiøded by Television bead or Manager
County Commission Approval
Recommend for U Approval 34 Denial
Request was: C Approved C Denied
comments /1/ ccjg1odc/r
Chairman By:
Comintmtatlons Manage, Humboldt 1V or Chairman, Quinn River or Denio 1V District
Lime
Date
VOUCHER This section to be completed by County Mminisfrato,’s Office Refund of Television!Radio Tax for reason stated above
n-&fR
Sêbove’’
Parcel# Parcel # Parcel # TOTAL I certify that the foregoing claim Is correct and just: bat the adivies specined have been received by the xoper officlais of the County, the Courts an&or pedai Districts, or the services stated have been erfcaned; and that they were necessary br, have ,een or vAn be applied to County, Court or special District purposes.
Authorized Signature
For Comptroller Use Only Date
,&
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-
This section to be completed I the person(s) reQuesting refund
Pay To:
Za7ez
Address:
J/I
)14aisc44J
Ai)
Fia”S A/fl±f V4 c’A, *N
C
V Quinn River Television District
9 9%
U
Assessor’s Parcel # 4Y3V-c 1-37e’ -a
Humboldt Television Department 500-000-52010 709-000-52020 710-000-52010
Denio Television District
S153
Physical Address:
lP/e certify that the television tax paid on the tax roll for the above parcel is incorrect because: Q”TWS parcel cannot be served by television/radio signals of the television district/department U There is not and will not be a television/radio receiver on this property during this tax year C The correct number of television/radio receivers for this property should be__________________ C Other Under pains and penalties of perjury, a felony, llwe swear that the above is hue and correct.
r
6/777
‘
3tgnathreofReftmdClsimantoat’ This section to be completed by Board at Cowdy Co.nmlnlanen
This satan to be ceaiøded by Television bead or Manager
County Commission Approval
Recommend for U Approval 34 Denial
Request was: C Approved C Denied
comments /1/ ccjg1odc/r
Chairman By:
Comintmtatlons Manage, Humboldt 1V or Chairman, Quinn River or Denio 1V District
Lime
Date
VOUCHER This section to be completed by County Mminisfrato,’s Office Refund of Television!Radio Tax for reason stated above
n-&fR
Sêbove’’
Parcel# Parcel # Parcel # TOTAL I certify that the foregoing claim Is correct and just: bat the adivies specined have been received by the xoper officlais of the County, the Courts an&or pedai Districts, or the services stated have been erfcaned; and that they were necessary br, have ,een or vAn be applied to County, Court or special District purposes.
Authorized Signature
For Comptroller Use Only Date
,&
ZC
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“ 1i’9
-
‘iii
j] ‘H
V
-‘S
Iii
‘I
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11
1
—-
