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COED= PROCUREMENT CARD TRANSACTION SUMMARY (LOO) <br />Cardholder: Diller,Della M AccountNlx: 9154 <br />01105=10 E30AM <br />, <br />it <br />h <br />dlb <br />ine <br />D <br />i <br />ti <br />if <br />Tr <br />i <br />' <br />General Aceourd No. . <br />-Trart Date. <br />Venddr Name <br />, <br />3 <br />em pruc <br />ase <br />us <br />escr <br />p <br />on (spec <br />y <br />ss <br />';-purpose) <br />on <br />azrsact <br />`Amount <br />'Account <br />Furl <br />Crg <br />_ <br />Pgm <br />firerd <br />piood, <br />1202009 <br />SHRM ORG <br />SHRM Mmnbms)dp <br />$160.00 <br />61881 <br />011 <br />8930 <br />87 <br />Total Statement Summary: $160.00 <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 Date: 121172009 <br />For lost/stolen cards, call: <br />Bank of America: (800) 305-7735 <br />Treasury Office: 682{5027 <br />d~ & 1 AL 5'W <br />Cardholder's Signature Date <br />R evred and Approved by/:~ <br />l6 1-5w <br />i is 6 Lure Date <br />