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4 .___1 h • <br />p 0 (" (4 <br /> n Yr. <br /> • <br /> L11Y OF E11l llt NOS CITY OF EUGENE POS <br /> 1820 ROOSEVELT BLVD1820 ROOSEVELT BLVD <br /> EUGENE. OR. 97402-4159 EUGENE. OR. 97402-4159 <br /> 541-682 4012 541682 4812 <br /> REPRINT REPRINT <br /> / 7 Refund <br /> Refund . <br /> xxx xx i . 7901 xxxxxxx$ x3462 <br /> VISA ------En rY Method: Manual VISA Entry Method: Manual <br /> Total: $ 25.00 Total: $ 25.00 <br /> 06/09/17 14;29:50 06/09/11 14:30:57 <br /> Inv a: 00004 Inv u: 00m15 <br /> 4:85 <br /> Apprvd: Online Apprvd: Online <br /> I agree to Par above total amount I agree to oar above total amount <br /> according to card issuer agreement <br /> according to card issuer avreement <br /> (Merchant agreement if credit voucher) (Merchant agreement if credit voucher) <br /> Merchant Cony nerchant Cony <br /> THANK VOWTHANKYOU! <br /> l:n. <br />