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' +Dregon Department of Transportation <br /> I N 1 ~ PAGE NO. 1 <br /> ILLING DATE <br /> t 04/03/OI 19:59 <br /> - EPORT.NO. <br /> 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-PEGGY HAMLIN FOR INFORMATION CONCERNING <br /> <br /> j 1858 PEARL 4TH FLOOR THIS INVOICE CALL.: <br /> 'EUGENE OR 97440 (503)986-3956 <br /> AGENCY T/C CURR. DOC. DOC. DATE VENDOR N0./SUFFIX UNIT <br /> 73 350 0000132900-84 9901 <br /> REVENUE AGENCY CUSTOMER CUSTOMER CUSTOMER <br /> ACCOUNT SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVF12323-000 O1 844010 21 4,976.69 17608 - PE <br /> ~ R~ ~g P;~a PS r. R @~~ <br /> AMOUNT DUE <br /> 734-1150A(11-88) <br /> <br />