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PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: Diller,DeBaM AccountNbr. 9154 <br /> <br /> <br />- - <br />- • <br />dfy it <br />usi <br />m <br />r;iess <br />mdruadl <br />tion (S <br />Descri <br />T <br />s <br />cti <br />[iennal Ledger Aocpunt No <br />pe <br />e <br />p <br />. <br />6 <br />p <br />ran <br />a <br />on <br />Trans Date <br />Vendor Name . <br />purpose) q <br />Amount. <br />Account <br />Fimd <br />Crg <br />.P,gai <br />firart <br />Pto scr- <br />182010 <br />DELTA OOSS2147186173 <br />DELTA 00682147186173 <br />$25.00 <br />61711 <br />011 <br />SW <br />87 <br />54 <br />(a <br />2010 <br />LCHRA <br />LCHRA <br />✓ $15.00 <br />61710 <br />011 <br />8830 <br />87 <br />Tod Statement Summary: W.00 <br />I, the undersigned card holder, do hereby ce" under penalty of perjury, that, to the best of my knov4edge, the materials furnished, services rendered, expense incurred, or <br />other Item of indebtedness as charged in the foregoing bill is a true and correct charge against the City of Eugene; that the claim Is just and due; and that payment for <br />these charges has not been requested or made from petty cash, department order or other method. / <br />Cardholder's statement Date: 06/17/2010 `G, . <br />Signature Date <br />For lost/stolen cards, call: Reviewed and Approved by: <br />Bank of America: (800)305-7735 <br />Treasury otrKe: 1182-5027 suIaatw ~OrIG~I~G~-eJ ~ • 255.2°l <br />eons sill a Date - <br />9~~NNE -PWA <br />DATE: <br />1NITIg1-5. <br />