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COFP0003 - PROCUREMENT CARD TRANSACTION SUMMARY (LOG) 06252010 352PM <br />Cardholder: Brintnall,Schkara <br />Account Nbr: 5557 <br />I, the undersigned card holder, do hereby cerbty under penalty of perjury, that, to the best of my knowledge, the matenals 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 gist and due; and that payment for <br />these charges has not been requested or made from petty cash, department order or other method. <br />Statement Date: 06/17/2010 Fy" &/; <br />c ho es e <br />For lost/stolen cards, call Re proved b <br />Bank of Amenca (800) 305-7735 , % (9 <br />Treasury Office Office 682-5 82-5027 <br />Signature <br />DATE: <br />SCANNED-PWA <br />DATE: <br />INITIALS <br />Date <br />0 <br />~P ~~zs <br />