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`~_o~ am/pm v:~:~:~.A .'~~ !?'~~•Sa'~~ Date Sec Req~d: ~_ _!~' T" "~~ HHG BILL OF LADING ~~S v4t~;':S~CI 5i. ~~iC ;;~~e, l. Or4 97 Pack Date: am/pm ., ~ ~ - Delivery Date Req~d: ~_~ _o? am/pm ~ ^ ~ v~j~'~ y `"~''} S~,-"~' ~ ^~a~ ~~Q3} ~ -~2~ B/L Number PUC ~037~42 1CC ~ti9.. ~:?3~15 Order 7a~cen ey: ~^^,~s - 3540 . NAME NAME •Qx -rT•• !'(~i ~•T'f"~ r+ m T:~T'C^ ~Tn~ ~^~ m.~ rr1T m r+nT?r^ ADDRESS ADDRESS ~ - ~ 1J0 H~'Gii ST~ET i.~',0 H~GH ST~r.~; CITY STATE ZIP CITY STATE ZIP St~•~`. ~~ Si~~i. ~ T ~i l'Z CONTACT PHONE CONTACi PHONE SUE ~..~MB 373-4349 Froc F,ox 5TART TIME: L l__I ~~ ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I INITIALS am/pm 6 AM 7 8 9 10 11 12 1 2 3 4 5 8 Pti1 FINISH TIME: NOON EXPLANATION: P-PACKING L-LOADING D•DRIVING UL-UNLOADING UP-UNPACKING X-TIME N(7T CHARGED • INITIALS am/pm MATERIALS MATERIAL PAiCKING UNPACKING AMOUNT IAOYIN , UNITS OT EXT. QTY. RATE ~Tlf. RATE QTY. RATE ~ .. f i _ ; -~ "1 TRUCK ~flFi~1lE~F( ~v• ~ ii i ( ;s ( , ~C BARRELS/DISHPACKS ; , r ! - ~'" ~ TRUCK 8 ,2 MEN ~ v' `!' ~ `" r 7. <- ~ t / ;~G; , ci'' CRATES/CONTAINERS EXTRA LABOR HOURS CARTI~NS: 1.5 CU FT. MATERIALS 3o Cu FT ~` - ' ^ - %? ^ ir - 16 !t~ ~' :a~ =,, ~-' ~'--~ . cLc 4.5 CU FT ~ ' '_i % `~-+,', f tj; 'y~ " ` .:~'o ~.c!^ ~i": s.o cu Fr ~. : ~r ..=. ~ ' :~ ~ -; r>':~, a y ` ~ :~ t U.3'~1,=~ WARDROBE CARTON ' -' S UBTO~T AL - MIRROR CARTON ~ • - ~ MATfRESS CTNS: SiNG~E .~ - J S~ - y'7 ~+-~-~,, y~ ~ a• YS `Q ~. ; 1 ~~ ~ cf~ DOUBLE . ~ ~l ~c - J `7 -'77 ? - ~~ ~.~i ~YS" • ~r( •~ ~U.~S~S,t QTHER '^ f ^~i - ~C~ ~' , ! f an 'w O ~7^i .7 OTHER: ~ ~ ~ =~'- ~7 ~ ~4 , rs . a ~ ~ -;J .r, --~ ~ '~'~ ~ ~Z. f ~-'/J , a; ~ • ~~ 7. ~ ~ F~:ti ! '~ . . . - st~srora~ - >,k. s . . uero~A~ - If the shipper deciines to sign this declaration of value and the shipment is accepted, DATE OF PICKUP REQUESTED DATE OF DELIVERY REOUESTED the shipment will mwe at the depreciated value protection level and the shipper will b@ SUbJACt t0 th9 BpprOp~IStB V81U8t1Of1 Chfl~C]@S. SK3NATURE/MaREEMENT 70 HIGHER CHAqGES DATE SIGNED ^ RELEASED VALUE PROTECTION: ,. ~ ,. Goods will be valued at 60 cents per Ib. per articie. : GROSS WT. TARE WT. NET WT. Shipper: Date: MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the actual weight of the shipment. For each $10Q0¢ d~ fracfion tbereof, of declared value at $1.25 times the weight of the shipmerrt in Ibs. or declared fump sum value, whichever' CHARGES FROM ABOVE is higher, the valuation charge shall be 50 cents ~r each $100.00 of value. CITHER CHARGES Shipper: ~ Date: ;' ~ Lump Sum Value: STORAGE CHARGES , ~ VALUATION CHARGES ^ REPLACEMENT COST~ PROTECTION: Goods will be valued at 53.50 times the actual weight o(the $hipment. For each $100.D0, or fraction thereot, a deciared ~a~~e TOTAL CHARGES ~. . '( { 5`a ~ at $3S0 times the weigM of the shipment in Ibs. or declared lurtip sum value, whichever . p is higher, the valuation charge shail be 85 cents per each $1Q0.00 of value. ~ ADVANCE DEPOSIT Shipper. Datei v _ ~, Lump Sum Value: ~,, ~'~ ~ - ~ . . ~ BALANCE DUE~ I acknowledge that I have received; af~e Grst contactwith the carrier, a copy of the C.O.D. BILL PREPAID form entitled GENERAL INFORMATION FOR MOVIf~G WOUSEHOLD GOODS OR RECEIVED IN GOOD CONDITION EXCEPT AS NOTED: OFFICES IN OREGON which explains the-~0-~gori rules .and fegulations affecting intrastate shipments of household goods arid office f~rnitti{~8(ic~ fixtures. Consignee: I understand that my final charge for service must b8based`on rates that have been approved by the Public Utility Commission and published in a tariff regardless of any Driver: estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE COMMENTS/EXCEPTIONS: IS NOT A FIRM BID. Dated: Shipper: Carrier: WTB NO. 50 Tf~IPI iC'3s:=