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Legacy Trogram Donation form <br /> Donor name: V - Ga 111 5 LC, CLie r5 <br /> Donor organization (if <br /> applicable):` -7 — <br /> /�t/ n / r d(/ <br /> Home phone: � (�(? 0/tv r W phone: !� 6 (O I/ 5 T72E-mail: )(tra iL cZ ('1 rj �tgD, L.�t,+A. <br /> Address: ?g 7 C r*4/ � , t,i-<, Q <br /> Park for donation: Cr- 5 #e (fit e,�Ir a(`P/I _G L91,0 _50„.A_ _F" <br /> i, <br /> Item description and location code (if known): 2 r(-:• <br /> / /� ��ly <br /> a. 14 <br /> L r\l(� r�G%1e cr r �, ' E&rt , 4. — <br /> Proposed location: <br /> ec'- )0C • /v 6.1 tAr • .. /i /. ' ..` <br /> Donation amount Z %k ka-r-c 4 44-0.4-:1,4_ ,‘ c pfztc, J1,,�:� vst,' y. Luc- : rr"'I -z 512-(C07-0,0 <br /> a OC�-kr U- U,.z.- -“Sid, i.111:06,— f J will k <br /> Special requests: ii t,t i,T u,► - e �( I �, .-- <br /> C S it l� , <br /> Inscription: �/A_ GOV1/n., v4* t4't +/ r9 CTr'r#3 (/3°-2O!2 <br /> Wlta 014 k (44 led 11.elf 11.e4Vie0-5SctK <br /> I SC SCC d►titrevo e 1,5 1( . f�ht��n <br /> CLIA. Cuw(uca Co-ua.wta <br /> SI have read and understand the donation policy. May we list your name on our Yes jE No n <br /> website Donor Hall of Fame? <br /> Donations are tax deductibThank y <br /> le <br /> Method of payment you <br /> Check made payable to City of Eugene gopa <br /> or your <br /> ❑ VISA I Credit Card # <br /> n Exp. Date J_ geiwrous support! <br /> Mail completed form and donation to: <br /> Katie Blair-Terrazas <br /> Parks and Open Space Planning <br /> 1820 Roosevelt Blvd <br /> Eugene, OR 97402 <br /> Questions? Contact: 1011k, <br /> (541)682-4831 or katie.a.blair@ci.eugene.or.us �� <br />