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Legacy Tro Dona <br /> Donor name: g I IC S IT /ATI <br /> Donor organization (if applicable): <br /> Home phone: I/ S $g o9 362 Work phone: ` S' g,2D - g - MO E -mail: g I Cx5 4 -775 6 N /fig xi <br /> Address: I iC C7. A?W\'/ CA., 9 f <br /> Park for donation: Q S c (_,QAPeN <br /> Item description and location code (if known): ( 1 5 42 3 <br /> Proposed location: <br /> Donation amount: (2 eg ! <br /> Special requests: <br /> Inscription: D 4ATf 6-1 7-( E rQI(4!/ e!i y QLS �c9 , � 1� b 5 <br /> /qcmc y CA ft2f7r q <br /> 1 have read and understand the donation policy. May we list your name on our Yes No n <br /> website Donor Hall of Fame? <br /> Donations are tax deduct - tee <br /> Thank y <br /> Method of payment: y <br /> Check made payable to City of Eugene <br /> j y our <br /> ammazia <br /> VISA Credit Card # <br /> Exp. Date generous /— sup port! <br /> Received: 8 -1 <br /> Mail completed form and donation to: Logged: 5 S <br /> Clara Matsler Letter: , <br /> Parks and Open Space Planning Ordered: <br /> 1820 Roosevelt Blvd Confirmed: <br /> Eugene, OR 97402 <br /> ns, EUGENE <br /> � ► <br /> Questions? Questions? Contact: a <br /> (541) 682 -4907 or clara.t.matsier @ci.eugene.or.us U e pace <br />