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coeaooas Pf~OCUREMENT CARD TRANSACTION SUMMARY (LOG) ~a~erzoos <br /> <br /> Cardholder: Peterson,Carrie Account Nbr. 8898 <br /> 19/2005 REGISTER GUARD ~ ~~LIC~..~ 5268.80 , q <br /> f l Total Statement Summary: 5268.80 1 <br /> ~2~-"~ <br /> I, the undersgned, do hereby certify under penally of perjury, that the materials famished, services rendered, expense incurred, or other item of indebtedness as d~argea <br /> in the foregoing bill is a true and correct charge against the Gity of Eugene; that the daim is just and due; that no part of the same has been paid; and that I am authorized <br /> to sign for the payee. <br /> Statement Date: 10/17/2005 ~ <br /> Cardholders Sig tare Date <br /> For kut/stolen cards, call: <br /> Bank of Ameriq: (800) 305-7735 ' <br /> T~a~~~ rx~• rsa~_~ro~ l ~ ~ ~a ~ ~ O 5 <br /> Supervisor ignature Date <br /> ~p ~ 31 _ ~ - Z~{vU <br /> <br />