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ORDER WORKSHEET FOR PROPERTY PURCHASE <br /> <br /> • 1~4~ 2QX~OU 3~fS'3 <br /> Date Check Needed: August 19. 1999 <br /> 2~~ r~- ~ 7~8 7 <br /> Mail Check ? Hand Carry Check Ox /a„/E # / `y/~~ SLYJ•Ov <br /> General Description: Acquisition price for proposed 4 acre Thompson park site. <br /> Dept. Contact: Engineering -Russ Royer ext. 5264 P xS83`I <br /> Vendor Name: Western Pioneer Title Com anv gw~9~ <br /> Address: 1200 Executive Parkway <br /> City/State Euqene. OR Zip 974 1 <br /> Phone: 484-2900 Tax ID for 1099: provided by escrow <br /> Prepay ~x Emergency Ox Separate Check Ox Route to: Russ Royer <br /> Line Amount: 5188.500.00 <br /> • Line Description: This is compensation for the purchase price of the park site to be <br /> deposited in escrow per terms of sale agreement. The purchase includes portions <br /> of tax lot number 400 on map number 17-04-02-30. This should use the Parks and <br /> Open Space acquisition fund number. If you need a more specific number, please <br /> check with Andrea Riner at 4909. Thanks. <br /> Date: 8/16199 Requested by: Russ Royer <br /> Commodity # - ORDER # - <br /> Line Account Codes XX XXX S <br /> XXXXX S <br /> s7sro3 yoS/2r <br /> Notes 3a/ 9.335 1~°oG -1~~~~ g 7 <br /> PWA-LRE c:\user\formslpropeny.frm 4!13/95 <br /> <br />