Financial- Vandermay Law Firm (Previous Tenant)

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~..- O~egon Department of Transportation Name ot Dlsplaced Orga~izatlon Mailing Address Owner: Teiephone Number. Q Business ^ Farm ~ Non-Profit RELOCATION FIXED PAYMENT APPLICATION File No Name $EQiOt7 Hignway County FAP No. I hereby app~y for the tfixed payment in lieu of reimbursement for all other moving and related costs and expenses. i certify that: ^ I am the owner of the above business, farm operation, or non-profit organization and that this business, farm, or non-profit organization is lawfully located on the rea- property from which my personal properry will be required to be moved. This business , farm, or non-profit organization has been in continuous operation since BUSINESS ~ This business cannot be relocated without a substantial loss of its existing patronage. ~ This business is not part of a commercial enterprise having more than three other entities which are not being acquired by the angency, and which are under the same ownership and engaged in the same or similar business activities. p This business had annual gross receipts of at least $5,000 or had average annual earnings of at least $1,000; or contributed at least one third of the operator's average annual net income from all sources, during the two taxable years prior to displacement. ^ The business is not aperated at a displacement dwelling or site solely for the purpose of renting such dwelling or site to others. FARM OPERATION p The acquisition of the land or part of the land resulted in the displacement of the farm operation, or ~ The acquisition caused a substantial change in the nature of the farm operation. NON-PROFIT ORGANIZATION Q The organization cannot be relocated without a substantial loss of existing patronage (membership or clientele). PP ~~^ e a e To the best of my knowledge, this applicant meets the criteria necessary to qualify for the fixed payment. g o ay gen a e Form 204 (11/95) RELOCATION FIXED PAYMENT APPLICATION Page 1 of 2 pages