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_ ,,:. <br />Oregon Department of Transportation RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES. NON-RESIDFNTI,4~ <br />Pay To: <br />Mailing Address <br />ClaimanYs Name <br />Q Business ^ Farm ^ Non-Profit <br />AGREEMENT <br />f <br />I am the operator of the business, farm, or non-profit organization located'at: <br />which is being displaced by the Oregon Department of Transportation. <br />it is agreed between the Oregon Department of Transportation and myseif that: <br />1. The business, farm, or non-profit organization, using its own resources shali vacate the above <br />premises within thirty (30) days of written notice from the Oregon Department of Transportation. <br />2. The above premises shall be left in a reasonably clean and orderiy condition upon vacation. <br />3. Upon completion and satisfactory inspection of the vacated premises, the Oregon Oepartment will <br />pay the sum of $_ _ _ <br />4. Attached is an inventory of the items to be moved. <br />5. Advance notification of the move is p required ^ not required. <br />CLAIM <br />I apply for moving costs in the amount of $ <br />items actually moved. I certiry that it is accurate. <br />Attached is an inventory list of all <br />The subject property was inspected on <br />orderly. I recommend the payment of $ <br />estimates are attached. <br />~ E. A. - <br />File No. <br />Name <br />Section <br />Highway <br />Counry <br />FAP No <br />and found to be vacant, cfean, and <br />_ be released. Copies of the move <br />AgenYs Signature <br />Date <br />Form 222 (11/95) RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-REStDENT(AL <br />