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Oregon Department of Transportation <br /> FISCAL YEAR REMITTANCE ADVICE <br /> 18 CHECK NO - 02803253 PAGE 1 OF 1 <br /> INV/CM DATE INV/CREDIT MEMO NO NET AMOUNT DESCRIPTION <br /> 01/13/18 R201800957 17,996.65 FUELS TAX REFUND <br /> FOR QUESTIONS ON THE PRECEDING INVOICE(S) CALL FUELS TAX GROUP, 888-753-2525 ( <br /> C0 \ 9 — aLleZ - I06 <br /> Inc o�►� C� <br /> t(4,4, O <br /> • <br /> ry <br /> }. :<� r } l ,x .K :S •kt�M{; <br /> 1 y i r} <br /> �- '„� }.¢i ♦l �� j .1. �. �, f� �... 'Y .t 3 <br /> -rTION LINE BELOW Q BEFO TOTAL PAYMENT <br /> $17,996.65 <br /> 0...w., Oregon Department of Transportation TO THE STATE TREASURER 96-10 02803253 <br /> FINANCIAL SERVICES MS #21 SALEM OREGON 97301 1232 <br /> 355 CAPITOL STREET NE PAYABLE THROUGH US BANK <br /> �JJ 1 <br /> wJ SALEM OREGON 97301-3871 ODOT DATE (31/16/18 <br /> ®lis503-986-3900 <br /> AMOUNT IN US DOLLARS <br /> ACCOUNT 73105 $17996.65 <br /> PAY SEVENTEEN THOUSAND NINE HUNDRED NINETY SIX AND 65/100 DOLLARS <br /> PAY TO THE CITY OF EUGENE PUBLIC WORKS DEPT VOID AFTER 2 YEARS FROM DATE OF ISSUE <br /> ORDER OF 1820 ROOSEVELT 02-0 <br /> E9L `'�—� <br /> EUGENE OR 97402-0000 <br /> AUTHORIZED SIGNATURE - <br />