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r <br />i <br />WORKSHEET FOR PROPERTY PURCHASE <br />Date Check Needed June 3rd or 190'. 2010 <br />Mail Check ■ Hand Carry Check XXXXXXXnx <br />General Description: <br />Dept Contact: Russ Rover ext 5264 <br />Vendor Name: State of Oreoon, by and through its Department of Transportation <br />Address: 355 Capitol Street NE. Room 420 <br />City/State Salem, OR Zip 97301 <br />Phone- N/A Tax ID for 1099: N/A <br />Prepay ■ Emergency Separate Check XXXXX Route to: Russ Rover <br />Line Amount $ 7.880.00 <br />Line Description: This is a purchase of ODOT surplus property, 5.43 acres WEP <br />surplus. Property north of tax lots 601 & 602 map 17-04-29 <br />Charge to :Account 531-9335-78000-975026 <br />Da I te: 6/1/2010 Requested by: Russ Rover <br />zolo 0114 5-9Z <br />1 <br />Commodity # - ORDER # <br />Line Account Codes XXXXX <br />XXXXX <br />Notes <br />PWA-LRE c lusefforms\property frm 4113/95 <br />SCANNED-PA <br />DATE' <br />INITIALS' <br />