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ss~ ~~:~ Date Ser. Req'd: -- am/pm Ct~~~iat. Ci#y Transfer C~~ am~pm 1465 JOhRSOtt St. NE, S81em, OR 973 DelrveryDateReq~d: _ am/pm {503) 5~1-6683 •{8~~ 82B-1S41 ~ f~(~03) 5Sf-6924 order Taken ey: PUC ~937342 • tCC MC 227345 ~U~J~y' ~E -i3-~~~? HHG BILL OF LADING ' B/t Number NAME MARION CO BUILDING INSPECTION . NAME MARION CO BUILDING INSPECTION ADDRESS ADDRESS CITY STATE ZIP CITY STATE' ZIP CONTACT PHONE FAX CONTACT PHONE FAX I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I~ . I ~ ~ ~ I ~ ~ ~ I START TIME: INITIALS am/pm ,_ 6 AM 7 8 9 10 11 12 1 2 3 4 ~ 5 6 PM NOON t~- EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPAGKING X-TIM N07 CHARGED fINISH TIME: INITIALS am/pm MAT~NALS MA' f~RlAl ' P~ICKING iJM~ 1kCtC~° "-"~lNT, , • ' ~MONiNC,i , N~T'S . : 47' ~XT. ` QTY. RA7'E 1~TY. RATE QTY. RAt`~ ~ 1 TRUCK & DRIVER BIIRpELS/DISHPACKS ' _ . _ . _ _;.:; ~~_. . . ._---_ . 7RUCK & 2 MEN ;`.,- . .._ y,.. , ~_ _..,_ ..-..-- ...._ CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1.5 CU FT. v~ _ MATERIALS S.~ V • U ~ ~,_;;, c 0 ~ ) ,. ) ~I-~~~ ^ - 4~s6i1.FFI ~p ~ ~ - ~ ~ ~ '"~~ pJ _ - WARDROBE CARTON ~( jgi'Q'~i _ f~, ~r: MIRROFJ CARTON ~ • - ~ ~ MATTRESS CTNS: siNG~e DOUBLE OTHER .+~r (} ~U y /I ~HER: r t~ ~~~ . . ~ . . . ~~ ~~~~, ~ ~~~ ~ . . ~ ~~~~ r~ If the shipper declines to sign this declaration of value and the shipment is accepted, the shipment will move at the depreciated value protection level and the shipper will DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED be subject to the appropriate valuation charges. I~iELEASED VALUE PROTECTION: 51GwaruR~ax~q~titEt+-T 1u H~HER cw~ES onTe siGNeo . ~ ~ ~~ Goods wil be lue [a`t 60 cents per . per article. - Y~' ~ ' ~ _ GROSS Wf, TRRE wf. - N~t' tMT: ~ J __ Shipper ..~ Date: MILES: ~ ^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the _. _,_ actual weight of the shipment..FS2f ~.~~~L$14.4Q~ or~ti94ttlgfe0t,-Of,deGl~[e~d.Y~lu~,_: at $125 times the weight of the shipment in Ibs. or declared lump sum value, whichever --.,~_~_..Y..~. _ _ v.- HX~~E$"~`R~FA`A~27V~ ~ ... . _ _ . _ _ --~_ __ ____ _.. _._ ._. is higher, the valuation charge shall be 50 cents per each $100.00 of value. pTHER CHARGES Shipper: Date: Lump Sum Value: STORAGE CHARGES VALUATION CHARGES ^ REPLACEMENT COST PROTECTION: Goods will be valued at $3S0 times the ac[ual weight of the shipment. For each $100.00, or fraction thereof, of declared value at $350 times the weigM of the shipment in Ibs. or declared lump sum value, whichever ~~~ ~~~R~~~, ~ q e~ is higher, the valuation charge shall be SS cents per each $100.00 of value. ADVANCE DEPOSIT Shipper: Date: Lump Sum Value: . .- `' E~AL~I~ICE .L~1~E ~ -~ . ~,~' I acknowledge4hat I have received, at the first contact with the carrier, a copy of the C.O.D. BILL PRE PAID form entitled GENERAL INFORMATION fOR MOVING HOUSEHOLD GOODS OR OFFICES IN OREGON which explains the Oregon rules and regulations affecting intrastate shipments of household goods and office furniture and fixtures. RECEtVED IN GOOD CONDITION EXCEPT AS NOTED: Consignee: I understand that my final charge for service must be based on rates that have been approved by the Public Utility Commission and published in a tariff regardless of any ._..~_~_-- Driver: ~~'-~ ~''~ ~~' --~t"' ~ estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE IS NOT A FIRM BID. D t d COMMENTS/ EXCEPTIONS: a e : Shipper: Carrier: WTB NO. 50 ^Jrr~~r~~ ~~ ~~r