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ODEP00.33 PROCUREMENT CARD TRANSACTION SUMMARY (LOG) <br />Cardholder: Diller,DelleM AccountNbr. 9154 <br />01/1912010 943AM <br />Desed <br />Lan (s <br />ecifyRem <br />urchasedbwsrrcessr <br />a <br />Tran <br />bde <br />',n ,tivreral LedgerAecoumNo <br />' <br />';Trays D to <br />VaMor Name` <br />~ <br />p <br />p <br />p <br />se <br />-Purpo ) <br />s <br />e <br />.Amount.. <br />- <br />Accourrt <br />Ftmd <br />Org.- <br />Pgm <br />Grant' <br />!Pmj~! <br />11112010 <br />LCHRA <br />LCHRA - Monthly meeting <br />1/ $15.00 <br />61710 <br />011 <br />8930 <br />87 <br />Total Statement Summary: 16.00 <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 item 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 payment for <br />these charges has not been requested or made from petty cash, department order or other method. <br />Statement Cate: 01/15/2010 <br />!N l Lam. / -/q '/0 <br />Cardholder's Signature Date <br />For lost/stolen cards, call: Reviewed and Approved by: <br />Dank of America: (800) 305-7736 <br />Treasury Office. 682-5027 - Gr <br />Supervisor's Slgnotu* Date <br />