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~, ~~ <br />Oregon Department of Transportation RELOCATION <br />SIGN, LOSS OF TANGIBLE PERSONAL PROPERTY <br />Pay To: <br />Mailing Address <br />Claimant's Name <br />Telephone Number <br />f. <br />File No. <br />Name <br />Section <br />Highway <br />County <br />FAP No. <br />I claim payment for the actual direct loss of my sign(s) as personai property. <br />I understand that I may be reimbursed for the actuai direct loss of my sign(s) when I am <br />entitled to relocate the sign(s) but do not do so. <br />The amount of such loss will be the lesser of: <br />1. The depreciated reproduction ~ost of the sign as determined by the Oregon <br />Depa~tment of Transportation (ODOT) less the proceeds from its sale; or <br />2. The estimated cost of moving the sign, but with no allowance for storage. <br />I understand that ODOT will not pay this claim until a release of the leasehold interest in <br />that area necessary for highway purposes has been executed. <br />The amount of my claim is $ <br />, which is based on the lesser of: <br />A. Depreciated reproduction cost less net proceeds from $ <br />sale <br />B. ODOT's estimated cost of moving <br />$ <br />DATE <br />$ E. A. AgenYs Signature <br />Oate <br />Form 303 (11/95) RELOCATtON <br />SIGN, LOSS OF TANGIBLE PERSONAL PROPERTY <br />