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<br /> WO ROmiALLA BLVD
<br /> tOGENt. OR. 91402-41b3
<br /> 541 682 4812
<br /> 22!'i2:05
<br /> 0'
<br /> 4 UkS RUN1 .
<br /> . eiri OF Mita POS
<br /> • 1820 ROOSEVELT BLVD
<br /> : [lava EU6ENE. OR. 97402-4158
<br /> 541
<br /> ,l,
<br /> C .682-4812
<br /> C '.d 1 , REPR ii ..-- — •::.- -
<br /> ______---------------
<br /> 15.00
<br /> $ lb.o.
<br /> Sale 1:Aall 15.80 1111111111111M111.1111111111111
<br /> $
<br /> xxxxxxxxxxxx8925
<br /> VISA Entry Metho(: SwiRed
<br /> otal: $
<br /> ' T 15.00
<br /> cw (* oullui Ns 07/2a/16
<br /> 052)nOMCVE11 BLVD 1632 •' .
<br /> vwkw. OR. !WW2-41.49 Inv 4: 000066001 •
<br /> b41 032-442 PPPr Code: 023161
<br /> APPrvd: Online
<br /> 1 agree to gar above total
<br /> Ul/c0,11,
<br /> according to card issuer ag=1°:nt
<br /> (Merchant agreement if credit voucher)
<br /> VW MI [
<br /> 11.1,1.Num: 170
<br /> tin.i. !Lime• E 1 own
<br /> necclumt 1.
<br /> SUSAN C WRING
<br /> • X i° 2. Rc. 6471„tc,
<br /> Into' : 1 Oerch4nt CCPy
<br /> Settlement kicce$5fu 1M YOU)
<br /> G150)( 1700a10133
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