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COEPOM PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: Dtter,Delha M Account Nbr. 9154 <br />0211aW10 105SAM <br />s <br />ni pu <br />sg - 4 <br />D <br />ipti <br />if <br />B <br />d <br />i <br />n <br />tlfti <br />In i <br />t <br />Oerufal Ledger Account No. _ <br />Traits Date <br />' Veiidor.Narnme <br />< <br />e <br />e <br />r <br />cr <br />o <br />(spec <br />hasa <br />s <br />rx <br />y <br />nac <br />ion <br />Amount <br />_ _ - <br />Account <br />ug <br />Ong <br />'Pgm <br />(irank <br />project <br />010 <br />LCHRA <br />HR Monthly Meeting <br />' $15.00 <br />61710 <br />011 <br />8930 <br />87 <br />Total Statement Summary: $15.00 <br />1, the undersigned card holder, do hereby ce" under penalty of perjury, that, to the best of my knowledge, 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, departmerd order or other method. Statement Date: 02 /1 71201 0 11~ 41ze-, 2-.4-10 <br />C/Ardholder's Signature Date <br />For lost/stolen cards, call: Reviewed and Approved by: <br />Bank of America: (800) 3057735 r``? <br />Treasury Office: 6825027 <br />Supervisor`s Signahme/f oat* <br />