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~ ~i ~aD . _ ~~ ~io i~ s--~~ . <br />'%~~-~ . - <br />~ ~~ ~~~ <br /> <br />Oregon Department of Transportation RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />Pay To: D 0 ~t <br />~/A h de R May .e <br />Maiting Address <br />q l 1. ~ti-, S~- . S. E. Sw: ~e. •2'~ 0 <br />Sal~~ 0 9~30~ <br /> <br />Claimant's Name <br />K. 1/~ n.(erc N~a <br />~ Business ^ Farm p Non-Profit <br />AGREEMENI <br />File No <br />Name <br />Section <br />Highway <br />County <br />FAP No <br />I am the operator of the business, farm, or non-profit organization located at: <br />s y~ C o~R E- S'E .~/E' , ,S'... ~~,~., oR q~3 0, ( 2....~ ~i. ) <br />which is being displaced by the Orego~ Department of Transportation. <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 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 ~ _ w.~e,s i~ w.o ~e.~. f~'^^,.+ef S a. L..,.. ~/~'•-.( <br />by G u,..+y - ~~o.e.o /.~•( •r.• /c,as. <br />5. Advance notifica ~o of the move is ^ required Q not required. <br />~ . <br />CLAIM <br />w.~e.t '~w.o .ts ~', •.H iv"~!t <br />I apply for moving costs in the amount of $~ q y 0. '° . Attached ~ <br />' I certify that it is accurate. ~ G;,~ <br />co:{~ .~ .~,..~.~..~ v~w.CaR~~~ a ~o~t~,~f '..{r. ~. <br />The subject property was inspected on ~'~~ZS(~~l 1 and found to be vacant, clean, and <br />orderly. I recommend the payment of $~G ~-tc~ . v0 be released. Copies of the move <br />estimates are attached. <br />~ E. A. ~ ~ ~ <br />~ AgenYs Signature ate <br />x <br />Fo~m 222 ~~ ~~95> RELOCATION <br />MOVE CLAIM BASED ON ESTIMATES, NON-RESIDENTIAL <br />