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~7~~1f ~~~~ ~~1~: <br />~~~~. C~TI~ ~~ ~~V~~ <br />J~E~ A~DR~f LDT B~T~V~~N ~~~' ~ ~~ T ~WY ~9N <br />BiL~ TO: <br />NAME: SAME AS ABOVE <br />BILLING ADDRESS: 182U ROOSEVELT BLVD <br />CITY :EUGENE STATE: OR ZIP: 97402 <br />~-~°r~: KR1STt I ~ I APT' <br />PHONE #: 547.882x4821 _ _ __~ <br />i ~ 7 <br />START DATE <br />08126109 <br />COMP DATA <br />08/28/49 <br />~l REP: GEORGE <br />1 <br />~ ~ ~~ <br />~l~~~ I <br />~AT~ <br />81~~1~9 <br />~~VIC~ ~#~~pTl~N <br />INS O~SD44 <br />°l~ Late f~~ ri~~ ~e ~h~r~d o~ a~~~u~n <br />per 3~ ~~~s ~~t ~u~ <br />Thank You For Your Patronage <br />~vT~~ <br />~ ~ ~ .~5 <br />`~~ <br />~ ~ <br />~..~~~ ~. <br />~~~ ~~ <br />U~ T~TA~, ~ ~ ~ .~a <br />TOTAL AMT $17 7.25 <br />~k_ °i°~ ~-~--j <br />dll-~i~::3i~- ~i~7:~ ~i <br />