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Donor name: <br /> LkJ k I 5 ©i/ti ftJ <br /> Donor organization (if applicable): �y� / <br /> Home phone :: // Work phon J z } {, ,)“31' -C~ /b _ E-mail: 4) lNCkel1 a !� ) ��i' �,� gIY►9v((tt! <br /> Address: 34'"/3 M � Ce,J �` i`Q v ¢�Y .s(4 Ped 12 P <br /> Park for donation: <br /> kern description acid Iota 'on code (if known): 'g / rO i i'1 R"4'4 Ii k] f <br /> Pr. _ . sed location: <br /> - <br /> Donation amount / <br /> Inscription: 14 e i V J tO t J <br /> 11).3 - fat <br /> I have read and understand the donation policy. May we list your name on our Yes No C <br /> website Donor Hall of Fame? <br /> Donations are 0 eauctih(e <br /> Met <br /> 7 hank- S —1 4 ` <br /> a Check made payable of payment: � � '^ �� � <br /> ble to City of Eugene Wj ` <br /> —46go for our p <br /> N VISA Credit Lara / * `Q g ewr ou n p s , <br /> Exp. Date ! / `v l $i' �� 1. <br /> a ag Mail completed form and donation to: <br /> Clara <br /> Parks and Mauler <br /> Open <br /> Parks and Open Space Planning Y � � • <br /> 1820 Roosevelt Blvd <br /> Eugene, OR 97402 <br /> Received: " r i '' �, U <br /> Questions? Contact ' _ _ <br /> Logged: - °- - - - <br /> Letter: <br /> Ordered: <br /> Confirmed: OfikAj <br />