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Oregon Department of Transportation <br /> PAGE , N0. 1 <br /> IIIING DATE <br /> / ~ tee' 08~02~U0 21 :12 <br /> C.~ / A"f y ~ EPORT N0. <br /> ~ jf'~.~ Ll~v~^~K. FMBL824-1 <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-JENNY LYMES I -.FOR INFORMATION CONCERNING <br /> 858 PEARL 4TH FLOOR ; THIS INVOICE CALL: <br /> EUGENE DR 97440 ~ L503)986-3956 <br /> I <br /> AGENCY T/C CURR.. DOC. DOC.DATE ?VENDOR N0./SUFFIX UNIT <br /> 73 350 Off00132900-84 9901 <br /> ACCOUNT ~ REVENUE AGERCY~ CI~STOMER CUSTOMER CUSTOMER <br /> SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVFi2323-000 Ol 843000 21' '5.,40 ~ 17608 - PE' <br /> _ ~tu~ ~4~~r ~~~~i~~6L c~ <br /> i; ~:~P~:~`N,~~ V~fi~~iDRAk~Jv <br /> FRS r~ ~"~t~R S;~~r:~~~A~t~ft AC ~~1r~T; <br /> t <br /> AMOUNT DUE <br /> s:: <br /> 7;4-usaaul-asp <br /> <br /> i <br /> <br />