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Oregon f~epartment of Transportation <br /> Y ~O ~ V ~ PAGE N0. 1 <br /> ILLING ?ATE <br /> 12/07/04 20:53 <br /> (COUNT ND. <br /> SEE BELOW <br /> TO ENSURE PROPER. CREDIT, RETURN A COPY OF THIS FORM WITH YOUR REMITTANCE T0: <br /> OREGON DEPARTMENT OF TRANSPORTATION <br /> 355 CAPITOL STREET NE, RM434 <br /> SALEM OR 97301-3872 <br /> OST-CITY OF EUGENE PUBLIC WORKS <br /> LGIP ACCOUNT #4909-PEGGY HAMIIN FOR INFORMATION CONCERNING <br /> :858 PEARL 4TH FLOOR THIS INVOICE CALL: <br /> EUGENE OR 97440 (503)986-3879 <br /> GENCV T/C CURR. DOC. DOC. ?ATE VENDOR NO./SUFFIX UNIT <br /> 73 350 0000132900-84 9901 <br /> ACCOUNT NO . REVENUE ~OENCY CUSTOMER CUSTOMER CUSTOMER <br /> SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVF14825-000 01" 844010 22 13,240.54 17483'.- CON;.` <br /> ~ <br /> _ , <br /> sW~ <br /> r <br /> 7~ <br /> g~ ~G~ ~fl8`6e~,. ~da~..a't.i3~t~k 8`1~Sd~~sw~~~~ <br /> - _ ~ ~ <br /> AMOUNT DUE $13, .54 <br /> ,i'' <br /> <br /> 734-1150FC11-88) <br /> <br />