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Gwen t < y8 qaraien <br /> Donation arm <br /> Donor Name: , l di Soo --"Sbi"x-lr 14 <br /> Address: / '.4 � /9e Sj /i?"C/ <br /> .", 1 r <br /> Phone: Home 'd � -.5e- s5 <br /> ( ) (Work) (Cell) <br /> Date: t7/... ✓ //-"0/3-- E-mail: in 'a" r a k r $f >42/44144 <br /> Donation Item: Rose Engraved Slate Tile-$750 ; • <br /> (Inscription:2 lines,24 characters each line max, rc, 1, ,, .._ 4,..40: <br /> including spaces and punctuation.) .�.:� � <br /> Submit your completed form before April 30 for summer installation, and before <br /> i. <br /> August 1 for fall installation. :„ , ' <br /> a <br /> First Choice Plinth Number .. '4M '� <br /> Position(please circle)iltaii South,gip <br /> West - <br /> Second Choice Plinth Number <br /> Position(please circle):No 1 ast, est <br /> Inscription: <br /> C�. `ori-ems 14a • A 11 �..�a_r. se rl <br /> �J <br /> Ue2Xn1,rd143a_�'d 1 �, 60r) <br /> — DONATIONS TO OWEN ROSE GARDEN ARE TA) <br /> Contact for more information: Katie Blair-Terrazas, Interim Park Deve <br /> 541-682-4831 <br /> Make checks payable to: City of Eugene -fl\-19 Y I /2-124 - <br /> Please mail completed form City of Eugene Parks Planning 7 <br /> and donation to: Attn: Katie Blair-Terrazas n 3 is <br /> 1P 3 <br />