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I <br /> re~- <br /> PHOTO REPRODUCTION ORDER/ LANE COUNTY 1.4-2. <br /> APPLICATION FOR PERMISSION TO DISPLAY HISTORICAL <br /> Lane County Historical Museum, 740 West 13th Avenue, Eugene, OR 97402 <br /> ~r Phone: (541) 682-4242 Fax: (541) 682-7361 <br /> Applicant Justin Grishkin <br /> Company City of Eugene Parks and Open Space Division <br /> Address 1820 Roosevelt Boulevard <br /> Eugene.Oregon 97402 <br /> Phone (541) 682-4913 Fax <br /> Intended Use For use in Ci of Eugene park display <br /> # of Glossy/ Reproduction <br /> copies Photo # Description Size Matte Fee <br /> GN6648 Harvesting peaches, Thramer farm Digital -email $7.50 <br /> GN7082 Apple orchard near Eugene Digital -email $7.50 <br /> GN7088 Man examining Lane County cornfield Digital -email $7.50 <br /> <br /> +rrr GN7097 Man in suit in field of grain Digital -email $7.50 , <br /> GN7177 Young man with box of loganberries Digital -email $7.50 <br /> Use fees for public display - $10.00 per image, S images $50.00 <br /> ~,4 c 5 5 d ~ ~ ~t~P.~ <br /> ~U,e~$y~~~ 22...2,........__....:, <br /> . ,rs~~. 52~a G <br /> #f ~ 2J ~ TOTAL DL7E: $87.50 <br /> The applicant agrees that this permission is subject to the conditions listed on the back this rm and further agrees to _ i <br /> promptly pay all applicable fees. <br /> Please complete, sign, and return copies, to Lane County Historical Museum. A countersigned copy will be returned to <br /> you when permission is grante . <br /> Signature of Applicant Date S- ~ ? <br /> Print Name and Title T h r k parr t <br /> Signature of Museum Director U Date ~ <br /> Order # 689 Payment Received Date <br /> 740 West 13th Avenue, Eugene, OR 97402 • PO Box 5407 0 5 - 21 - ~ ~ ~ ~ ~ ' ~ ~ I N <br /> (541) 682-4242 • fax (541) 682-7361 •info®lanecountyhistoricalsociety.org • www.lanecountyhistoricalsociety.org <br /> <br />