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_ _ _ <br /> Oregon Department of Transportation <br /> x,.. o <br /> ~ ~ ~ ~ ~ PAGE N0. 1 <br /> IIIING DATE <br /> 06/01/04 21:14 <br /> CCOUNT N0. <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 /> 4 <br /> OST-CITY OF EUGENE PUBLIC WORKS <br /> LGIP ACCOUNT #4909-PEGGY HAMLIN FOR INFORMATION CONCERNING <br /> <br /> 1 858 PEARL 4TH FLOOR THIS INVOICE CALL: <br /> .EUGENE OR 97440 (503)986-3879 <br /> - - - <br /> GENCY T/C CURR. DOC. DOC. DATE VENDOR N0./SUFFIX UNIT <br /> 73 350 0000132900-84 9901 <br /> REVENUE R6EMCY CUSTOMER CUSTOMER CUSTOMER <br /> ACCOUNT NO . SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVF14825-OOQ Ol 844010- 22 15,.357.97 T7483 - COM <br /> SS _.r ' <br /> c~~~ f~e9qq <br /> F Y <br /> . .L iF~v , <br /> AMOUNT DUE ,$i5 7 9~ <br /> 734-1350A(I1-68) <br /> <br />