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r, ~ r+ . i <br />/ • ~ `f' !1 <br />Marion CountiJ <br />OREGON <br />FAX (503) 588-5495 <br />Salem, Oregon <br />T O: Fax Number <br />Company Name <br />Attenrion <br />F r o m: Sender Name <br />,~ ~/-.~~SS <br />~-G7-~~~ , C'~- <br />..~.c~-~ ~~., ~-- <br />c~ <br />Department _ __ ~' _ - _ ~~'~/~ <br />Telephone Number ~ ~ 0 ~ ~ ~~~ <br />n <br />Budget/Project Number (For County Use Only) <br />Number of pages (incfuding cover): ~ <br />If transmission is interrupted or of poor quality, please notify us immediately at (503) 588-5165. <br />Date ~~7 <br />/ <br />FORM 1 f-PS2B White Copy - Fiscal Services Can Co Customer <br />arY PY - <br />Rev N92 <br />