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City of Eugene <br /> Public Works Maintenance • <br /> Public Works Parks and Open Space <br /> 1820 Roosevelt Boulevard . <br /> Eugene, OR 97402 <br /> .Tele # (541) 682-4800 Eugene <br /> Fax # (541) 682-4882 <br /> RECEIPT <br /> Date 10-10 —1 <br /> • From <br /> Address <br /> City/State/Zi p <br /> Quantity Description Amount <br /> C a fie- foAientept-4 -ec-1 <br /> ���J <br /> TOTAL <br /> (4 O <br /> Payment: ❑ Cash check# 0 Credit Card <br /> Received by <br /> L <br /> 96-505-1232 <br /> AKSHAY S.GUPTA MD 13 8 7 <br /> 5115 FOX HOLLOW ROAD y <br /> EUGENE,OR 97405 l0.4 1 V <br /> v V <br /> §, G '. uk, m I $ <br /> PAY <br /> = Sl 11T GW*1(-1i { (Y ) DOLLARS B a s <br /> i$ UMPQUA BANK <br /> 1-8664UMPQUA <br /> (1-866-486-7782) <br /> W W W.UMPQUABANK.COM <br /> , 1111 <br /> FOR <br /> L <br />