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Q~tgr~ID~caff»~nr a~Tra~,sporbnavr <br /> . ~ I ~ ~ O ~ ~ ~ PA6E NO . 1 <br /> • ~ SEEING DATE <br /> 10/05/04 21:19 <br /> coon No. <br /> SEE BELOW <br /> TO ENSURE PROPER CREDIT, RETURN A COPY OF THIS FORM WITH YOUR REMITTANCE T0: <br /> OREGON DEPARTMENT OF TRANSPORTATION <br /> 355 CAPITOL STREET NE, RM434 <br /> SALEM OR 97301-3872 <br /> EUGENE, CITY OF <br /> GRANT ACCT PEGGY HAMLIN ! FOR INFORMATION CONCERNING <br /> ;858 PEARL STREET THIS INVOICE CALL: <br /> .EUGENE OR 97401 (503)986-3879 <br /> 6ENCY T/C CURR. DOC. DOC. DATE VENDOR NO./SUFFIX UNIT <br /> 73 350 52918 -00 4901 <br /> REVENUE CUSTOMER CUSTOMER CUSTOlEA <br /> ACCOUNT NO . SOURCE iouea AMOUNT DUE AMOUNT REMITTED REV REFERENCE <br /> RVF141.28-000 01 844010 22 978.71 14248-CON-E <br /> RVF13016-000.. 01 844010. 21. ` : 3,602.59 : 17483 PE <br /> Pte( <br /> D <br /> sz ~ <br /> Przo~E~ X05 ~ ~ <br /> X33 q 3z G ~so~t~? a,g t ~ <br /> ~ <br /> 3,1c~2. <br /> 0 <br /> AM <br /> U <br /> <br /> 73M11CW131-uf <br /> <br />