Laserfiche WebLink
,~ . <br />Oregon Department of Transportation <br />MOVE CLAIM BASED <br />RELOCATION <br />ON ESTIMATES, NON-RESIDENTIAL <br />Pay To: ~ 'D 0 ~ <br />~/q ~n de R May <br />Mailing Address <br />q l 2~4, St . S. E. 5~.~.: ~<. .2 y 0 <br />Sa1eM,. b 9 730~ <br />ClaimanYs Name <br />K. 1~,~ h.la.r~ NLa <br />~ Bu'siness ^ Farm p Non-Profit <br />AGREEMENT <br />File No <br />Name <br />Sedion <br />Highway <br />Counry <br />FAP No. <br />i am the operator of the business, farm, or no~-profit organization located at: <br />S y 7 ~' o~ R~- S'E . N E' , ,S'... l~ w. , O R °1 7 3 0/ ( 2.w! ~/, ) <br />which is being displaced by the Oregon Department of Transportation. <br />It is agreed between the Oregon Department of Transportation and myself that: <br />The business, farm, or non-profit organization, using its own resources shall vacate the above <br />premises within thirty (30) days of written notice from the Oregon Department of Transportation. <br />The above premises shall be left in a reasonably clean and orderly condition upon vacation. <br />3. Upon completion and satisfactory inspection of the vacated premises, the Oregon Department will <br />pay the sum of $ <br />4. Attached ~ .~~e,e } w,o -c.. f,'..,.,.+eJ S u. i,.,.. • h<<..( <br />by Co w..+y - ayop~t.a r.t.( •+~•• vc.r2s'. <br />5. Advance notifica ~o of the move is Q required ^ not required. <br />~ <br />CLAIM <br />R~.t '~w.0 .tv ~'.'w~ vTtl <br />I apply for moving costs in the amount of $ 3 9 y o. °° . Attached ~ <br />I certify that it is accurate. <br />Got~ ~ w~.v.~..~ 1/~w~Csit~~~ .~ ~a~ l`'f ' ~ • {s. _ G~ <br />The subject property was inspected on ~'~'Z~~G 1 and found to be vacant, clean, and <br />orderly. I recommend the payment of $ ~ G~-IC~ - UO be released. Copies of the move <br />estimates are attached. <br />$ E. A. ~ ~ <br />7 <br />Agent's Signature ate <br />Fomn 222 (11/95) <br />RELOCATION <br />~ <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />