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~~~~ <br />~~~ .~ ~ <br />Captta~ CQa~r~s S~~U~ce. ,~nc. <br />POST OFFICE BOX 265 • SAIEM, OREGON 97308 <br />Phone:(503)399-8366•Fax:(503)399-8366 <br />Service Billing <br />~4~ ~9,. <br />silling Date:~ ~~9g <br />~~a <br />T . Ms.7J^alerie ik' ~`~ <br />~c~ ~~4 ~4~i•ion unt <br />Q't -' ~ M ' owrthouse <br />Of"~ S~' ~' ~ 0 gh eet N.E. - Sth Floor <br />~ •' ~ Sa , OR 97301 <br />-' -~ -a <br />,;, ,~ ~ ~~ <br />RISIC NMNAGEMF.~T <br />Our File Number: D70380F <br />Insured: Marion County <br />Claimant: Pomelow, Chad <br />Claim #: <br />Date of Loss: 3/20/97 <br />IRS#: 93-0842926 <br />~ Q,~ <br />~ <br />`~ ~ Adjusters Hours 3.7 @ 35.00 $ 129.50 <br />~' (~ ...-------: -------------------------•-•---------------------------------------------•---•--------------- <br />~J Mileage 0,0 @ 0.00 $ 0.00 <br />----------------------------•--------------------------------------------------------------------_..---- <br />Photo 0 @ 0.00 $ 0.00 <br />----------------------------------------------------------------------------------•--------------------- <br />Adjusters Expense $ 0.00 <br />-------------------------------------------------------------------------------------------------------- <br />Total Loss / Salvage $ 0.00 <br />EvaEuation / Condition <br />-------------------------------------------------------------------------------------------------------- <br />Photo Copy $ 0.00 <br />-------------------------------------------------------------------------------------------------------- <br />Phone $ 1.80 <br />------------------•--------------•---------------------------------------------------------------------- <br />File Set-up Charge $ 8.50 <br />-------------------------------------------------------------------------------------------------------- <br />Postage $ 3.35 <br />Office Expense $ 20.00 <br />Total $ 163.15 <br />! ~ ~ ~ ~ j ~ $9 <br />~ ~ <br />~~ U <br />