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~...> <br />~ <br />Oregon Department of Transportation RELOCATION <br />RESIDENTIAL OCCUPANT INTERVIEW <br />~ _ <br />^OWNER ~]TENANT <br />Property Address _ ~~~_~~~~, ~~ ~~ <br />Date of Occupancy -S Contract Ren~~ <br />Attach copy of rental agreement or rent receipt <br />Estimated Monthly Utility Costs: <br />Electricity~`/ Z~ Heat <br />Water -~- Sewer --C -- <br />File No. <br />Name <br />Section <br />Highway <br />County <br />FAP No <br />ESTIMATED TOTAL GROSS MONTHLY HOUSEHOLD INCOME <br />If rent + utilities is greater than 30% of the total gross household income, displacee must complete <br />income verification form and provide complete state and federal returns. <br />SPECIAL RELOCATION NEEDS OF THE RELOCATEE: <br />UTILITY OF DISPLACEMENT DWELLING: <br />REPORT OF PERSONAL INTERVIEW: <br />Right of Way Agent. <br />Date <br />Form 101 (6/95) RELOCATION <br />RESIDENTIAL OCCUPANT INTERVIEW <br />