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r0EP0033 PROCUREMENT CARD TRANSACTION SUMMARY (LOG) 12202010 1 10PM <br />Cardholder. Eva, Kathy <br />Account Nbr. 4652 <br />a <br />eot <br />11242010 STAFFORD VIDEO PRODUCT <br />copies of SPLASH songs CD $90.00 <br />62900 535 <br />8921 41 <br />Total Statement Summary. $90.00 <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knovAedge, the materials furnished, services rendered, expense incurred, or <br />other Item of indebtedness as charged in the foregoing bill is a hue 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 r <br />Statement Date: 12/1712010 /a"/v1- CS ~Q <br />Cardholder's Signature Date <br />For lost/stolen cards, call Reviewed and Appro v y <br />Bank of Amenca (800) 305-7735 <br />Treasury Office 682-5027 12- <br />Supervisors Signature Date <br />&01~jllO <br />SWJ3 <br />