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CO P0033 PROCUREMENT CARD TRANSACTION SUMMARY (LOO) <br />Cardholder: Diller,Della M Account Nbr. 9154 <br />02128r2011 9:32AM <br />r c. <br />_ <br />Ir7 - _ <br />m.a i <br />: <br />. - <br />` <br />_ - _ <br />- ' • <br /> <br />~ ' <br />- _ <br />0e <br />ie <br />l <br />> s <br />,-ai <br />ae , : 5.` ` <br />; r <br />- <br />f t~ <br />J v <br />' <br />, <br />Descilptlon(ape'elfy.i mpurefiasedlbusfness_ .yr <br />• <br />' <br />° <br />- <br />Tratisadfionc> <br />' <br />r-~, <br />r <br />ra <br />at Aecount No <br />_ _ <br />- <br />G <br />' <br />Tans Date <br />t. - <br />;rvh <br />" - x.,. w, <br />Verhdnr Name? <br />uia£ <br />1 ) <br />1x T <br />i <br />1; PurPoae) <br />I <br />~ <br />Account' FLaid <br />Ora 3 . Pgrri Orant_ Prod <br />1/3112011 <br />INK4LESS <br />Ink for Printer <br />$58.98 <br />62300 <br />011 <br />8930 <br />87 <br />Total Statement Summary: $58.88 <br />1, 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 Rem 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. 9Aam.. <br />Q <br />Statement Date: 02/17/2011 <br />2 ' ZS <br />Cardholder's Signature Date <br />For lost/stolen cards, call: Reviewed and Approved by: <br />Bank of America: (800) 305-7735 nnnn~~nvv/d <br />Treasury Office: 682£027 AAA//G77 / 1 /r P <br />Supervisor's Sit "um Date <br />IF-7 <br />Z~ <br />