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Oregon Department of Transportation RELOCATION <br />SUBSTITUTE PERSONAL PROPERTY CLAIM <br />Pay To: ('~ ~Av~~t~~A <br />L~ r- ~ ~ w. <br />-' . <br />Mailing Address ~~ o ' <br />o Z~ <br />Sf S'.E • r~~ . 2~(~ <br />S'.,:~-,.,~ , ~~ ~C 7 3 0~ <br /> <br />Claimant's Name <br />SA~ ~ <br />a~o~2. <br />~ elepho~e Number: ~~p 3~ ~ p p_ O ~ ~ 3 <br />ai Q <br />File No. <br />Name <br />Section <br />Htghway <br />County <br />FPP No <br />If an item of oersonal prope~ty which is used as part of a business or farm operation is <br />r~t mo~~ed but is promptly ~eplaced with a substitut~ item that performs a co~nparable <br />`~~ncti~n at the replacement site, the payment will consist of the lesse~~ of: <br />A: The cost rf the substitute item, includinc,~ installation costs at the rzplacement <br />site, min~as any proceeds from the sale ar trade-in of the reulaced item; or <br />F~: "rhe estimated cost of moving and reinstalling the replac~d item but with no <br />aliowance for storage. <br />My ciaim is based on the following: <br />~I Items: ~e.¢ c~p~-.'b,~ s-4- a-1~ ~~-; b~ o K~~s<s ~'~ ~=~-- _"" ~em. ~ b~ t(~ ~ Ns ~ <br />~-- --- <br />~I f•.. Re^laccment Cost, ~ncluding installation, less net pi oceeds of sale, or trade-in A. ~ <br />aliowance (Attach documentation) ~ S~ Q~t 3, 3 3 <br />I B. Sta;e's estimated cost of moving (Attach estimates)~'~ I B' ~^~~A ~I <br />-~ <br />Aniount Claimed (lesser of A or 8) <br />$ 5,9~3.z <br />~~~- ~'- ~~ - <br />GaimaM's S~~nature <br />Amount ApproveC EA AgmCs Signature Date <br />L - <br />,~ NO ~~~;`~ ~' I,~t~f ~~~' ~~~~/ Lp ~,~ Reviewe(sSignature <br />Liv~ci. <br />~,s f+-~~ u~ .'n /o ..; /~(.' -1 G~ ~t vi+~o I.' ~I--i e M. Uate <br />/ <br />~ ~ fo ~¢ ~ t/C ' ~ ^'Q `"~ ,~i <br />T~s.c ,'-~t.-,~ ~''~~c ^~i Xc~ ~ ~ K..~,,.~.., ~'1.,~,~.,'r..o <br />h..o` ~--t o ~u 6 4 . Z -F' c~'v' ~„ ~ ~ . '-, rQa~. o~.~.P /.~.c.'o,. ~ ~~o ~ q ~' ~. <br />h ~ ,~~. <br />L ~17iG ~.e. ie .~j r <br />~r v <br />Form 207 (11/95) SUBSTITUTE PERSONAL PROPERTY CLAIM <br />