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~~ ~T~ ~~ ~V~~~ <br />JQB A~~R~~: ~~~ ~~ ~~ <br />BILL TO---- -___. _ ----. <br />NAME: SAME AS ABOVE <br />BILLING ADDRESS: 1820 ROOSEVELT BLVD <br />CITY :EUGENE STATE: OR 21P; J'~M12 <br />A~r~: KRISTI I i tJ lJ <br />PHONE #: 541-682-4821 <br />~A~`~ <br />!~ 8~~9 <br />~R~I~ D~R~PTl~I~ <br />INS ~~~9~~ <br />~°l~ date fee ~v~~i be barged ~~ a~~o~r~ <br />after D dais Past due <br />n nit re~si~e fir rae <br />.ter,le9e,er r yes <br />Thank You For Your Patronage <br />~ ToT~L <br />I ~ #124 <br />START DATE <br />09/18/09 <br />COMP DATE <br />09/18/09 <br />REP: GEORGE <br />C~1~--C~i~~~~ <br />~~lt~r <br />C. ~' (,_3~.}{AFC.) ~~~ , j~"> -i i., <br />i/V~l ~°~1.,~.~- `',dam <br />~..~ <br />.~ <br />~..~~.~ <br />T~T~IL <br />$3~,7~ <br />~~,~~ <br />TOTAL AMT $237.75 <br />~ I f :~-C~C~~'1 <br />~~--~ ~~~ <br />C~(~ l _. ~ ~ ~~ r .~ (r~ f ~ ~~j <br />