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,~ ~ <br />Oregon Department of Transportation RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />Pay To: <br />~(A n de R May -~ ~ o l~. <br />Mailing Address <br />q t 2~~^, St . S. E. 5~.~.: ~~.. .2 y o <br />Satew. 0 9 ~3ot <br /> <br />ClaimanYs Name <br />K. 1~~ n.ter~ Nla <br />~ Business ^ Farm ^ Non-Profit <br />AGREEMENT <br />I am the operator of the business, farm, or non-profit organization located at: <br />S y 7 C o Krt E' S'E • N E, 5... l~. r.~. , D R °1 7 3 0/ ( 2«..! ~/, ) <br />which is being displaced by the Oregon Department of Transpo~tation. <br />It is agreed between the Oregon Department of Transportation and myself that: <br />1. 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 shatl 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 ~ . .~R,s ~ we .c.. ~ ,'.r.,.~-el S c., i,." ~ ~'..,~ <br />by Cow.~+y ~ ~o~pR.o /s.~ •w. v~,k.f. <br />5. Advance notifica ~o of the move is ^ required ^ not required. <br />~ <br />CLAIM <br />~~ ~o .~e ~-, ~.,,, :.~Fe.r x <br />I apply for moving costs in the amount of $ 3 9 y o. °° . Attached ~ <br />I certify that it is accurate <br />~.vf{~ ~ ,v~,.~.`..~ 1/~w~srt~,~.~ ~ ~o~~~,'f ,~••~s. - Gj~ <br />% <br />The subject property was inspected on `"~ Z~~G ~] and found to be vacant, clean, and <br />orderly. I recommend the payment of $'~ ~ y~ . UO be released. Copies of the move <br />estimates are attached. <br />$ E. A. <br />\ ~ <br />7 <br />Agent's Signature ate <br />Form 222 (11/95) RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />