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r - f- <br />COEP0033 <br />Cardholder: Tinfle,Robert <br />1114/2010 1 BED BATH & BEYOND 9319 <br />1/14/2010 1 SHOPKO 00400986 <br />PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Employee Recognition Event <br />Employee Recognition Event /P 4" <br />Total Statement Summary: <br />Account Nbr: 0277 <br />$7984 <br />65117 <br />011 <br />8910 <br />87 <br />$79 84 <br />65117 <br />011 <br />8910 <br />87 <br />11118120101002MA <br />1, the undersigned card holder, do hereby certify under penalty of pe0ury, that, to the best of my knowledge, the materials fumished, s rvices 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 i ust a due, and that payment for <br />these charges has not been requested or made from petty cash, department order or other method /l q "a, <br />Statement Date: 11/17/2010 Ca o s Signature Data <br />For lost/stolen cards, call Reviewed and Approved by <br />Bank of America. (800) 305-7735 <br />Treasury Office, 682-5027 /T _/9 <br />Supq isor's Signature Date <br />~\z <br /> <br />