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Arer,~on Department of Transportation <br /> ` ~ PAGE N0. 1 <br /> ~ ~ ~ V~ ~ C E ILLING DATE <br /> 11/02/04 21:30 <br /> CCOUNT N0. <br /> i <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 WOkKS <br /> LGIP ACCOUNT #4909-PEGGY HAMLIN FOR INFORMATION CONCERNING <br /> 858 PEARL 4TH FLOOR THIS INVOICE CALL: <br /> EUGENE OR 97440 (503)986-3879 <br /> <br /> 1 <br /> GENCY T/C CURR. DOC. DOC. DATE VENDOR N0./SUFFIX UNIT <br /> 73 350 0000132900-84 9901 <br /> ACCOUNT NO . REVENUE AGENCY CUSTOMER CUSTOMER REV CUSTOMER <br /> SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REFERENCE <br /> RVF14825-000 O1- 844010 22 12,503.90 -17483`- CON' <br /> ti r~, <br /> ~ 1 ~ c <br /> ~ C ~ ~ { y - <br /> ;t~ 3r ¢ <br /> . ,i <br /> L~~ .3~s <br /> AMOUNT DUE $12,5:90 , <br /> 734-1350Af 11-88) i <br /> <br />