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£eacy Pagrain Z)onatio <br /> Donor name: VA ca \ .13e <br /> Donor organization (if applicable): <br /> CEL. e S4 5n -� ∎9 , <br /> 1��n� phone � -- rk phone: E- mail: O(`eJpv�bec CS►1neCiS�' <br /> Address: `.O a Spmg k.as s �r�ve ���ne� ola cf1'0 1 e-k- <br /> Park for donation: l4 ..` l -ec GG c,n <br /> Item description and location code (if known): PCOr V- BE3(1 CrN Pl c< 8 fit`-' 2e-p,Q Ce iit't n <br /> 4 <br /> Proposed location: <br /> Donation amount: *ZOO do <br /> Special requests: <br /> Inscription: LOU ltd `=C MEm 0'2. y OF <br /> M fvf2 tr✓ kia2ms=s -f 13G <br /> zooms <br /> R / 1 have read and understand the donation policy. May we list your name on our Yes No L <br /> website Donor Hall of Farra¢& <br /> Donations are tax d ecCuctibCe , AL I �i lc -t — <br /> Method of payment: l l <br /> Check made payable to City of Eugene N,LIA p 0 c3/4- c Nok, <br /> 44 S$OS &Vida 551 latpick_ce__ Pia • • . <br /> i <br /> VISA I Credit Card # <br /> Exp. Date 7 _I I (p <br /> 1 ` fi�Q�pe,j -t- 6 cZCD D 0.CC+ <br /> Mail completed form and donation to: Lc <br /> Clara Matsler L <br /> Parks and Open Space Planning C ("xpl T C , p ktua 1820 Roosevelt Blvd Cc <br /> Eugene, OR 97402 --J <br /> Questions? Contact: 4 1 - 9,0g <br /> (541),682 -4907 or clara.t.matsler @ci.eugene.or.us xE :•. <br /> detiiirnawk <br />