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~ ~'~"=~~ ~-/-/~D L~ 9'/O /~~.s~'1~..., ~ ~~ /~% ~:~~ <br />/ .~ . ,~ <br />Oregon Department of Transportation RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />Pay To: ~ T O ~ Fiie No. <br />VA h de R May U <br />Mailing Address ~ ~ ~ y O Name <br />q ~'.L. ~~ St . S. E. w; r. <br />,S b 9'I 3 O 1 Section <br />0. ( tw~ <br />Highway <br />ClaimanYs Name County <br />K. V~ ~ ~e,~ N~a <br />~ Business ^ Farm ~ Non-Profit FAP No. <br />AGREEMENT <br />I am the operator of the business, farm, or non-profit organization located at: <br />S Y 7 ~' o k R E- s'E ./V 6, ,S'.,, l~ct w. , O R °I 7 3 0/ ( 2.~! ~/, ) <br />which is being displaced by the Oregon Department of Transportation. <br />It is agreed between the Oregon Department of Transportation and myself that: <br />The business, farm, or non-profit organization, using its own resources shall 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 orderly condition upon vacation. <br />3. Upon completion and satisfactory inspection of the vacated premises, the Oregon Department will <br />pay the sum of $ <br />4. Attached ~ . .~at ~ wo .e.. f ,•.....+eJ S w L .«.. • /5~'~.( <br />by Gun.+y ~ ~~o~t.o /.c.( •,~,• vLas. <br />5. Advance notifica ~o of the move is ^ required p not required. <br />~ . <br />CLAIM <br />~~e.t -~•o .ee ~-, ~.M ~.-Fu 7( <br />I apply for moving costs in the amount of $ 3 9 y o. ~° . Attached ~ <br />I certify that it is accurate. <br />r~os~ ~ wv. ~.~..~ 1/~w~artM~l~~ ~ ~a~ t~,'f ,1 ~ • ts. _ - L' <br />The subject property was inspected on ~~I Z~~~l 1 and found to be vacant, clean, and <br />orderly. f recommend the payment of $'?L~ ~--(~ . UO be released. Copies of the move <br />estimates are attached. <br />~ E. A. <br />\ ~ 7 <br />Agent's Signature ate <br />Form 222 (11/95) <br />RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />