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Oregon Department of Transportation <br /> ~ ~ ~ PAGE N0. 1 <br /> . ILLING DATE <br /> 05/01/01 19:53 <br /> EPORTNO. <br /> 1 <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 /> 858 PEARL 4TH FLOOR THIS INVOICE CALL:. <br /> i EUGENE OR 97440 (503)986-395b <br /> <br /> i <br /> AGENCY 'T/C CORR. DCC. DOC. DATE VENDOR N0./SUFFIX UNIT <br /> 73 350 0000132900-84 9901 <br /> <br /> ~ REVENUE nGERCY CUSTOMER CUSTOMER CUSTOMER <br /> ACCOUNT SOURCE SOURCE AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVF12323=000 `O1 844010 21< 3';807.34' 17b08 - PE <br /> <br /> II <br /> <br /> I, <br /> - - <br /> THE ABOVE APJ~G~r~fT F~~S S~E~ 4.tiT' ~?R ~,t~ <br /> fROi~ YQ R S7ATE TR~tIRY A~ t~U~ <br /> - ~ <br /> AMOUNT DUE ~-~-~6-,~ <br /> 734-IIiOA(11-88) <br /> <br />