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COEP0033 PROCUREMENT CARD TRANSACTION SUMMARY (LOO) 0312812011 1003AM <br />Cardholder: Diller,DellaM AccountNbr. 9154 <br />_ <br />- <br />f<i .H~ia- _ f <br />- <br />fk= n 't <br />-Deserl o <br />heir <br />u rchised <br />u <br />Ine`s <br />' <br />'T <br />a` <br />ti <br />Le ei Account No. <br />"al <br />Tramdate <br />_ <br />Vendor Name <br />n <br />I! <br />ro <br />a_ <br />a <br />;.purpose) _ <br />r <br />nsac <br />on. <br />Airoum <br />Aeeourd <br />Fund <br />,Org <br />Pgin <br />Arent <br />project <br />2/2612011 <br />AMAZON MKTPLACE PMTS <br />Book - Get Rid of Performance Review <br />$15.13 <br />62300 <br />011 <br />8930 <br />87 <br />Total Statement Summary: $15.13 <br />I, the undersigned card holder, do hereby certify under penalty of perjury, that, to the best of my knowledge, the materials furnished, services rendered, expense incurred, or <br />other kem 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 ayment for <br />these charges has not been requested or made from petty cash, department order or other method. vz: <br />S) g- <br />Statement Date: 03/17/2011 / zzeAlh <br />Cardholder's Signature Date <br />For lost/stolen cards, call: Revi;W~~ ( <br />Tank of America: (800) 305-7735 <br />Treasury Office: 8823027 l <br />Su rvrsor's Signature Date <br />ctP <br />