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O~egon Department of Transportation <br />Pay To: <br />Maihng Adtlress <br />~ Claimant's Name <br />`~ <br />RELOCATION <br />SITE SEARCH CLAIM <br />Pile No <br />Name <br />Section <br />Highway <br />County <br />FAP No. <br />i am applying for payment incurred in searching for a replacement site. ' <br />I understand that i may be reimbursed for the acutal reasonable expense in searching for a replacement site, not to <br />exceed $1,000. Such expenses may include costs of transportation, meals, lodging away from home, and the reasonable <br />value of time actually spent in the search, i~ciuding the fees of real estate agents or real estate brokers. <br />All expenses claimed, except value of the time actually spent in the search, must be supported by receipted bilis. Payment <br />for miles driven may not exceed 20 cents per mile. <br />Payment for the time actually spent in the search shall be based on the applicable hourly wage rate for the person(s) <br />conducting the search but may not exceed $30 per hour. <br />DATE MILES DRIVEN RATE PER DAIIY HOURS SPENT RATE OF PAY OAILY MEALS 8 <br />MILE CHARGE CHARGE LODGING <br />Subtotal of Mileage Charges $ Subtotals $ <br />This is a certified statement of miles driven, hours spent, and other expenses while searching for a replacement site. <br />Total Claim $ <br />Comments to support claim approval: <br />$ E n. <br />Agenfs ignature ate <br />Reviewe~s Signature Date <br />Form 203 (7/95) RELOCATION <br />SITE SEARCH CLAtM <br />