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` Oregon Department o~"1`ransportation <br />` RELOCATION <br />REESTABLISHMENT CLAIM <br />Pay To: <br />Mar Po Federal Credit Union <br />Mailing Address~ <br />20 Chemeteta NE <br />Cfaimant's Name <br />Jim Eberle, CEO <br />File No <br />Sect~on <br />Highway <br />Counry <br />Marion <br />FAP No <br />I claim the follovuing costs incurred in relocating and reestablishing my small <br />business, farm or non-p~o~t organization. I have attached actual receipts to <br />verify my expenses, and I have included written support for all estimates. My <br />claim is based on the follovving: <br />Repairs or improvements required by law, code, or ordinance. <br />Modifications to accomodate the business operation. <br />Construction and installation costs for exterior signing <br />Provision of utilities from right of way to improvements <br />Redecoration or replacement of soiled or worn surfaces <br />Licenses, fees and permits not paid as part of moving expenses <br />Feasibility surveys, soil testing and marketing surveys <br />Advertisement of replacement location <br />Professional services in connection with the purchase or lease of a <br />replacement site. <br />Estimated increased costs of operation during the first 2 years at <br />^the replacement site for such items as : <br />A. Lease or rental charges <br />,B. Personal or Real Property Taxes <br />C. Insurance Premiums <br />D. Utility Charges, excluding impact fees <br />Impact Fee or one-time assessments for anticpated heavy utility <br />usage <br />Other (explain) <br />Total (reimbursement not to exceed ~10,000) <br />$ <br />$ 46,056.61 <br />$ 977.50 <br />$ <br />$ <br />$ <br />$ ~ <br />$ <br />$ <br />$ <br />37,213.44 <br />$ 9,104.88 <br />$ <br />$ 13.800.00 <br />$ <br />$ <br />$ 10,000.00 <br />a~man ~gna ure <br />ae <br />I E. A <br />$ 10,000.00 - <br />Form 205 (11/95) <br />~~ ~-P~.~ ~-~y-~7 <br />Agent's Signature Date <br />Reviewer's Signature pate <br />RELOCATI4N <br />REESTABLISHMENT CLAIM <br />