Laserfiche WebLink
~ <br />Oregon Department of Transportation RELOCATION <br />SUBSTITUTE PERSONAL PROPERTY CLAIM <br />Pay To: `~ ~Av~~t~~A <br />L~ r- ,•~ w. <br />~ <br />Mailing Address <br />~~p 1 z l~ <br />Sf s'.E. t~~ . Z~r~ <br />S~.~L-ri_ , 02 . ~t ~ 3 0~ <br />~~ <br />ClairnanYs Name <br />S A^^~ 4.o <br />q~o o v 2. <br />-elephone tvumber: ~~0 3~ ~".89 ~ p 0 3 3 <br />0 <br />File No. <br />Name <br />Section <br />Highway <br />County <br />FAP No <br />If an item o# qersonai prope-ty which is used as part of a business or farm operation is <br />r,~t mo~~ed but is promptiy replaced with a substitut~ item that perforrns a comparable <br />`;anction at the repiacement site, the payment will consist of the IessE~~ of: <br />A: The cost r•f the substi#ute item, including instailation costs at the rzplacement <br />site, r~iin~;s any proceeds from the sale cr trade-in of the reulacEd item; or <br />B: ~The estimated cost of moving and reinstalfirig the replac~ci item but with no <br />aliowance for storage. <br />My ciai~-n ~s based on the following: <br /> <br />Items: ~e~¢ c~P~.'o,~ s-E a-~ ~~; b~ o K~.~s<s ~~ ~.~.c..~c:~. ier-~. ( bK t 1~ rNs ~ <br />- ---- <br />~~ <br />' F.. Re .lac~ment Cost, ~ncluding instaNation, less net proceeds oF sale, or tra~e-in A. ~ <br />al~owance (Attach documentation)''r t, Q 4 3, 3 3 <br />~ B. Sta:e's estimated cost of moving (Attach estimates)~'~ <br />i B. S N/ <br />, - <br />II Aniount Claimed (lesser of A or B) <br />~=_=- - _- -_ <br />s, ~'1 3• ~ 3 <br />-- <br />~~~'F,e~'`u-.- ~- // ^-~^-a~-e..r <br />ClaimanCs S~~nature . <br />Amount Apo:oved EA Aqenfs S~gnature Date <br />L_ - <br />'~ Np ~,~~,t~~ q ~ ~~.f.~~f ~t~ ~n~ro~t~~ ~„~~ ReviewefsSiqnature <br />e2~s ~+-~~ ~..e ~'~ lo ~..' l.( .' ~ ee ~e n~-o I.' 3--s s N. Uate <br />~ ~ ~ ~ ~'Q `"~. R c <br />?'~`-~,s~ ,'-~c.+,~ F't~ec ~X~.f ~S fa '~e »i.a.e '6 ~ /?-•"~rn,'rao <br />~,,.0~ ~ o~t ti. 6 Ce. . Z'f' efir w~.u ~''+ r~a.e. e-~.~.P ~ie.'o.. 7~0 .~o c~~i '~. <br />Lj~ "//~IG ~tK.~j r a.~' <br />v r~ <br />Form 207 (11/95) SUBSTITUTE PERSONAL PROPERTY CLAIM <br />