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`y ~ <br />Oregon Department of Tronsportation RELOCATION <br />SIGN MOVE BY QUALIFIED MOVER <br />Pay To: <br />Mailinq Address <br />ClaimanPs Name <br />File No. <br />Name <br />Sectio~ <br />Hignway <br />Counry <br />FAP No. <br />You may select any q~alified mover to move your outdoor advertising sign. When you have selected a <br />mover, fiil out the information and return this form to the Oregon Oepartment of Transportation Right of <br />Way ~Agent assigned to you. Your agent will then cbtain estimates of the cost to move your sign. <br />I am applying for the relocation payment for actual and reasonable moving costs. I understand that the <br />payments are limited to costs of moving up to 50 miles, and that additional charges for moves over 50 <br />miles are usually not eligible for payment. 1 certifiy that: <br />• I understand that payment will be made directly to the moving company. <br />• I will leave the premises clean and o~derly. <br />The following estimate is based on the attached move specifications and conditions. <br />r~° ^ Based on assumed move of 50 miles distance <br />~ Q Based on a move to <br />The subject property was inspected on and found vacant, clean, and orderly. I <br />recommend that payment in the amount of $ be approved. <br />$ E. A. <br />AgenYs Signature <br />PAYMENT APPROVED: oa`° <br />Reviewe~s Signature Oate <br />Form 302 (11/95) RELOCATION <br />SIGN MOVE BY QUALIFIED MOVER <br />