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' °-=,s.-~irtuat Me~•chant <br />.~` " . .. .. <br />' OR STATE LANDS <br />775 SUMMER ST NE <br />SALEM, OR 97301 ~0~~ s r v~w <br />503-986-52'83 ~~ a -1 <br />OR .STATE T,ANDS <br />0017340006012594829000 <br />Date: 03/04/2008 02:17:50 PM <br />CREDIT CARD SALE <br />CARD NUMBER: **********,9981 06/09 K <br />TRAN AMOUNT: $350.00 y <br />APPROVAL CD: 014285 <br />RECORD #: 001 <br />CLERK ID: saw <br />X <br />Jenifer Willer <br />I AGREE TO PAY THE A$OVE TOTAL AMOUNT <br />ACCORDING TO THE CARD ISSUER AGREEMENT . <br />(MERCHANT AGREEMENT IF CREAIT VOUCIiER) <br />Merchant Copy <br /> , <br />. . t ..~. _ ii . . ~ . . .._• __ _ _ <br />Page 1 of 2 <br />