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Oregon Department of Transportation <br />,mkJ <br />~ ~J <br />~,K'~ <br />,r.~CJ <br />~~ <br />~~J <br />I am applying for payment incurred ~n sea~chi~g for a replacement site. <br />y <br />RELOCATION <br />S1TE SEARCH CLAIM <br />Fik No. <br />Name <br />Sedion <br />Highway <br />County <br />FAP No. <br />I understand that I may be reimbursed for the acutal reasonable expense in searching for a repia:,ement site, not to <br />exceed $1,000. Such expenses r:iav include cosis of transportation, meals, lodging away from home, and the reaso=~ahie <br />value of time actually spent i~ the search, including the fees of real estate agents or reai estate brokers. <br />All expenses claimed, except value of'he time actualiy spent in the search, must be supported by receipted bills. Payme~~.*. <br />for miles driven may not exceed 20 cents per mile. <br />Payment for the tirne actually spent.in the search shall be Lased on the applicable hourly wage rate for the person(s) <br />conducting !he search but may not excead ~30 per hour. <br /> S 8 <br />~AILY MEA' <br />DATE TMILES DRIVEN RAfE ~rR <br />„A~~~ ~AILY <br />CHARGE HOURS SPENT RATE OF PAY •- <br />CHAFtGE LJDGIh1G <br />Q ~1 ~ . ~0 _~. ~ ~ 3~. ~ ~rn ~~ ~ 0 c~ <br />~ <br />--- <br />~, ~ p o-+ ,~ _ <br />2 r o r"° <br />~ - <br />~~ ~~ - -~~ - <br /> <br /> <br />~ ° j: 2o <br />-~----- <br /> <br />-- z.~ <br />- <br /> <br />2 - °-~ ~-- <br /> <br /> <br />2 30. <br /> <br /> <br />0, ~• <br /> <br />,. o. ~ - <br />~ ~ ., - <br />~, < <br />_ <br />~ 2 a Y 3 i~ __ ~_~ <br />~ ~~ ~ - <br />.~ ~~--1- - ~ <br />2 ~ 0 6 <br />2 a °i -~ _i ~ <br />2 U I ~' . ~-~ . <br />- a . `z' <br />_ c( . ~'° <br />~a o ~ <br />~ ` 6b . ~ T- _ _ -.i <br />~~ - -- <br /> <br />, , <br />i _-..-. <br />-- ~ '- ,. <br />_ _ <br />/ ~ O. -w <br />-- <br /> <br /> , _~. <br />~ <br />_ ~ . - - _ -~, - <br />[- Subt~tai of Ulileage Charyes ~~ 2 Z~'° ~ ~uo~o~a~s ~.~ t u~v_,_: ~ ~ <br />This is a c•°rtitied statement of m:les d <br />Total Claim $ ~ l ~~• ~'° <br />ng for a replacement site. <br />/ ~-~ ~ 1 t- ,P~ - ~' o <br />Comments to suppor, ciaim appr;;val: ,/ / '/ ~~~~~ / ~,~ (~ <br />'rc,,, o ~ ~'~-- -f ,".e m_r' ~iSZ.! il~ a..L S i ~~l~o .~ ?~j V ~~f.~r ~ ~,~-.Q i~~.cY~~, 'Z~ir °` v~.us --'~~ <br />-~__ ~~~ S ~ ~,..~,~ ~ ~ ~i '~.vr ,~' <br />~A~ ~' » ~ _ <br />~ E. A. <br />Fo~m 203 (7/95) <br />_~~~ <br />-~s <br />vjvo v e. ~u ~C _~~ `~'~ <br />.~ ~ ~,e , <br />Agent's gnature ale <br />Reviewe~s S~qnature Date <br />RELOCATION <br />SITE SEARCH CLAIM <br />