Financial- Vandermay Law Firm (Previous Tenant)

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Oregon Department of Transportation Pay To: ~7-/ ( h-C VAh~tR~I C4.c.~ T'°~~Rw. Mailing Address: ~ 1'2 ~ S~. S. ~. S'~~.. 24 0 S•.-~-,,.... , a2 -~t 7 3 0 ~ Claimant's Name S A~ -~-~ a. .~ 4~ o v e i claim the following costs incurred in relocating a~d reestablishing my smaii business, farm or non-profit organization. I have attached actual receipts to verify my expenses, and i have included written support for all estimates. My claim is based on the following: Repairs or improvements required by law, code, or ordinance. Modifications to accomodate the business operation. Construction and installation costs for exterior signing Provision of utilities from right of way to improvements Redecoration or replacement of soiled ~~r worn surfaces Licenses, fees and perm~ts no~ paid as pa~t of moving expenses Feasibility surveys, soil testing and marketing surveys Advertisement of replace;n?nt location Professional services in connection wiih tne purchase ~r lease of a replacement site. Estimated increased costs of operation during the first 2 years at the replacement site for ~uch items as . A. Lease or rental charces B. Personal or Real Property Taxes C. Insurance Premiums D. Utility Charges, excluding ~mpact fee~ Impact Fee or one-time assessments far ant~cpated rnavy utility usage Other (explain) -4 = ~ ". $ ,.. ..-. Total (reimburseme~not"to exceed $ i0,U00) ..,_ - ~~ $ ~ °' ~ _ _...~. ___ __ ,...... ____ ..... __.._.__._. ~ aiman ig~na{u e ~ ~~ - l~! GF `T-~~- RELOCATION REESTABLISHMENT CLAIM File No. Section Highway County FAP No $ $ ~ ~90. °~ $ $ $ $ $ $ 3~6-2~ $ $ Gs, C3 ~. 62 $ $ $ - $ ~ E. A. ~ AgenYs Signature Oate Form 205 (11/95) Reviewer's Signature Date RELOCATION REESTABLISHMENT CLAIM