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_ ___ ___________ <br /> _ _ ___ _ <br /> Parks X- Open _space Do-nation I <br /> Donor name: <613travA-Aey <br /> Donor organization (if applicable):uc f tt ((��}} <br /> JI <br /> Home phone: 4 (y . ( 1)1+7 Work phone: 6 '39-5:-"Mdo E-mail: ` G co G^ " <br /> Address: Iii - _.ce,b . Av`e„ Cuievt, dYZ. Q-r-f <br /> Park for donation: J \ A1l•Q,rz, @, A-A-e. <br /> Item description and location code (if known): f)itykGA 1 >A V P e 0( 1 0ru .0)� , <br /> P f-T j-{-- - I-4 g Arl\< -V E LAN/ g \ V-p �<-�-- 1'.1 .5-\ /,11,1, e._Sv7Tt-e J <br /> Proposed location: <br /> -r- , <br /> Donation amount: GD 7 L ° p �l J G� 25,0 f- .. <br /> _ <br /> Special requests:, . gie - <br /> ��• , <br /> Inscri P a • i L✓i , A i 41, L i/, ' _ <br /> 6. FaaMl/ ii, am d. - _ if • . S • ail <br /> 6 re." mirmiliti67. 21.--.r..:,.-7-, <br /> I have read and understand the donation policy. <br /> Donations are tax cIeductihle <br /> Method of Tatn> you <br /> payment. <br /> Check made payable to City of Eugene your <br /> frir <br /> 1-71 VISA Credit Card# <br /> Exp. Date- .---' genercus su it <br /> I I i...-:,,-,fi ) <br /> Mail completed form and donation to: <br /> Heidi Schroeder <br /> Parks and Open Space Planning <br /> 1820 Roosevelt Blvd <br /> Eugene, OR 97402 <br /> lit <br /> Questions? Contact: ^�` <br /> (541) 682-4902 or heidi.l.schroeder@ci.eugene.or.us Eugene <br />