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Oreqon Deparfinent of Transportation <br />File No. <br />Section <br />Highway <br />County <br />FAP No <br />1 claim the following costs incurred in relocating and reestablishing my smail <br />business, farm or non-profit organization. I have attached actual receipts to <br />verify my expenses, and I have included w~itten support for all estimates. My <br />claim is based on the following: <br />Repairs or improvements required by law, code, or ordinance. <br />Modifications to accomodate the business operation. <br />Construction and installation costs fo~ exterior signing <br />Provision of utilities from right of way to improvements <br />Redecoration or replacement of soiled ~~r worn surfaces <br />Licenses, fees and permits no~ paid as pa~t of moving expenses <br />Feasibility surveys, soil testing and marketing surveys <br />Advertisement of replace;n~nt location <br />Professional services in connection with tne purchase ~r lease of a <br />replacement site. <br />Estimated increased costs of operation during the first 2 years at <br />the replacement site for such items as . <br />A. Lease or rental charces <br />B. Personal or Real Prope~ty Taxes <br />C. Insurance Premiums <br />D. Utility Charges, excluding ~mpact fee~ <br />Impact Fee or one-time assessments fo~ ant;cpated hnavy utility <br />usage <br />Other (explain) ~-~~ <br />$ <br />$ .~ ~ 9 p °-~ <br />$ <br />$ <br />~ <br />$ <br />$ <br />$ 3~6-2s <br />$ <br />~ <br />~~. 033. ~~_ <br />$ <br />$ <br />$ - <br />$ <br />$ _ <br />, <br />Total (reimburseme no~ to exceed $ i0,U00) , ~~ $ J 0, a-~ • <br />~._ ' _--~ <br />_ _. _ - <br />...___ __. ~ <br />~G~a,~.~-.-r.h, ~ ~~-+~~ _ - P~ ~ / ~~~ <br />aiman igna ure . <br />$ E. A. ~ <br />Form 205 (11/95) <br />Agent's Sig~ature Oate <br />Reviewer's Signature Date <br />RELOCATION <br />REESTABLISHMENT CLAIM <br />RELOCATION <br />REESTABLISHMENT CLAIM <br />