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P <br />COEPOM PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: Diller,Della M AccountNbr. 9154 <br />09/23!1010 328PM <br />- <br />' r <br />e <br />ite <br /> <br />i <br />d <br />li <br />e <br />u <br />Trar <br />i <br />^ <br />•General Le <br />Account too: <br /> <br />- <br />:Trans Date. <br />"Vendor Name';. <br />el <br />?i puro <br />s <br />ineas, <br />Onor <br />p <br />r (ap <br />as <br />dtb <br />-~purpose)= <br />.faad <br />on <br />Amount ~w <br />'Account <br />Fund <br />_ <br />Ong. <br />, ;Pgm <br />- <br />Grant <br />. <br />:Project. <br />082010 <br />LCHRA <br />LCHRA - Training <br />$15.00 <br />61711 <br />011 <br />8930 <br />87 <br />Total Statement Summary: $15.00 <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the materials furnished, services rendered, expense incurred, or <br />other gem 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 />Statement Date: 09/1712010, lLL{, 7-340 <br />Card s Signature Date <br />For lost/stolen cards, call: Reviewed and Approved by: <br />Bank of America: (800) 305-7735 ~\in~.,.ti / . L' <br />Treasury Office: 882{h027 //~-,,jjff am? <br />/ /Q <br />upervisor's Sreture Date <br />