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1 STATE OF OREGON REMITTANCE ADVICE <br /> TO SIGN UP FOR DIRECT DEPOSIT PAYMENT SERVICE AND RECEIVE CONVENIENT,ELECTRONIC <br /> PAYMENTS, LOG IN TO HTTP://WWW.OREGON.GOV/DAS/EGS/FBS/SFMS/PAGES/ACH.ASPX ON THE <br /> INTERNET. CLICK ON FORMS AND BROCHURES. THEN SELECT DIRECT DEPOSIT (ACH) <br /> AUTHORIZATION FORM. <br /> WARRANT NO. <br /> 125657175 <br /> JUDICIAL DEPT ;( r (503) 986-5600 <br /> INVOICE NO. INVOICE DATE INVOICE DESCRIPTION AGY DOCUMENT AMOUNT <br /> LANE COUNTY JU 011320 JUROR ATTENDANCE EXPENSE 198 VI285360 $10.00 <br /> LANE COUNTY JU 011320 MILEAGE 198 VI285360 $3.00 <br /> \ <br /> 1 ( <br /> ._ - t.io v4 Gik\sT- - , <br /> * 41(N-co/--? Wei cie us\ t ,_ , <br /> \- \73A1-- <br /> % C V\Se' 'AL i <br /> 10 <br /> jj <br /> VENDOR NAME , ISSUE DATE WARRANT AMOUNT <br /> 01/13/20 $13.00 <br /> HAXBY,BRIAN COLLIN <br /> r <br /> STATE OF OREGON THE STATE TREASURER ON <br /> 503-986-5600 PAYABLE BANK 96-10 of o WARRANT NO. <br /> JUDICIAL DEPT 1232 ,,. 125657175 <br /> B163D STATE ST CHECK DATE F._—. w' :•)o <br /> SALEM OR 97301 01/13/20 ... ='� <br /> 6 PAY THIS AMOUNT <br /> $13.00 <br /> THIRTEEN AND 00/100 DOLLARS <br /> PAY TO THE ORDER OF: <br /> VOID 2 YEARS AFTER DATE ISSUED <br /> 400XRUBY AVE COLLIN <br /> EUGENE OR 97404-0000 AUTH RIZED SIGNATURE <br /> II■ L2565 ? L ? 511' i: L2320010io: LO50L11'. <br />