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MAY 2~ '9~ 14~~~ PP.UDENTIAL
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<br />~' ~ C-apita! -City~Ttanst+~'' . HHG BI~L-OF~ LADIt
<br />~ 97 Tear povss~v ~. 14$.5 Johnsan S.t~NE. Saiom. OR 973fl3. ~ ~~
<br />a~[Ya~,`~~e a`•a ~3r. -97 Move aRv (5ti3) 581-S8S3 • f800) 828-1641 • fax (503? 583-6924 ~ 8!L Number
<br />Orae+ Te~arc B: -.. PUC ~~i~Z ~ ICC AAC 227345 3580
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<br />NA1AE - NNfE t
<br />Dz. Harlav .-! .:-, '-. ~/ r. Harlo
<br />ACORESS j ~' ,= - ~bCAESS ;
<br />525 Couzt~At. 1160 bert St. ~ £.
<br />CI~Y ~ 'CE. . 2JP
<br />~ CI'fr STATE ZIP
<br />- . ..02`~ QII`°.
<br />~~ $2.~5~~'• ~ ' ',:r'.S ~2ID OZE OIi
<br />CANTAG'f GHONE CONTAC7 " - ~ PHONB
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<br />Victoria '.. ~ F~uc 363-3311 f FAz
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<br />li~~ii~ili~ l~iili~~li~i(~ ~l~iEl ~~~iiiil~i4~~i~liiP
<br />~ IN ITtN.S a~
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<br />6 AM 7 $ 9 10 1 t Fi NLSN TINE:
<br />NOON
<br />EXPLANATiON; P-PACKit3G l•LOADING D-DRIYlKG UL•UNlOADING UP-UNPACKING X-TIME NQf CFiAAGED iN mals m
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<br />~; ` ~~~~ : C~Y. RAl'E, , .I~~ ,,,~A'A7E ~T'Y.' ~W "fiE` ; 1 TRUCK & DRIVER 30.00 I
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<br />BAFiREL3J01SHPqCKS i_(• _ .. , . , .,».ys~ .. ~ , .
<br />TRUCK~d~ 2 AAEN . . a.~,-~ . ,
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<br />GAATESlCO~fTAINER$ ~r .~0 EXTRA LABOfi 1iQURS '
<br />CqRTpNS~ 15 CU fT. , A U G.00 MHTERlALS " ~7d •
<br />3-0 CU FT ~ :~ ~ 70 OTHER ~--
<br />d5 CU FT ~
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<br />WARDROBE CARTON .,b ,y`~a`.4,,; ~ • :,',,, ~. "~
<br />MIRROR C/1RTON' - . • ' '
<br />MarrA~SS CTNS: s+r~,c~~ /f'3 S~ ~e
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<br />~r tna~atslppar declines co s~gn this declara~ion oe ~raius and [ne shipmerrt is accepcee, o"T~ o~ ~cK~v s~nu~~ arE oF oeuv~ v UESTED
<br />the shipmerR wiu move at the depreciatad v~ue pratsctlon leval and the ahipper wlll
<br />be subject to the eppropriate raluffiioe charges_ r a •,:, aue SiGNEo
<br />Ly~i~ ; ;nt,,..q,~4, y~ ~~~ a~.a,:Y~T`~'"!~K
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<br />RELEASEDYAWE PROTECTION: -~'-
<br />Goods wi b valued cgp,ts peI ltL per ani. ,r ~
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<br />Shippe~: /....s, ~. MILES: ~
<br />QDEPRECIATED VAWE PRQTECTION: GOOGS w111 be valued at $1.25 times the
<br />actusl weigM of the Shlpmer-t. For es.ch 3tOQD0. Or fraaion.thereot, d Qeclared ralue ABOVE
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<br />in Iris or'declsred Idm~t'abm vatue
<br />25 times Ene v~elght d ttie enipmeM
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<br />is higher, 1ne valualfon charg6 shall be 6Q cerAS per eacn SI00.00 of value. ClTHER CHARGES ~
<br />Shippgr: Dete: ~ ~- ~.
<br />Lump Sum Value: SfORAGE CHAAGES ~ ~
<br /> VALUATION CHAAaES 4
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<br />^ REDt.AICEMENT C05T PROTECTION: Goods wlll be v8lued st 33,50 t(me5 the
<br />ectu~ weight of the shipmenc. For each 5100-OQ a trar~lon shereof, ot declerad value ~, _; ::,
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<br />is hlg~er, ttfe valuas"son charge shall ba 85 cenis per each 5100.00 ef value. ADVANCE DEP0.SR . -
<br />Shippec Date: : n, " ' , -2 1 `
<br />k..ump Sum Value;
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<br />~ aeknawled e tnae ~ na , e ~ C O 0. ', BI ~ P EPAID
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<br />~IiOLD (300DS OFi :
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<br />,~ENEFiAI, lNFORMAT{ON fOR' MOYJt~G
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<br />OFF{CES IN :OR~oON whlCfi;~tplal~s ~ihe O~sgon ru19a, arld .reguLjtions eH9cttr-g :
<br />imras~te ~Aipmer~ of f~ouseFioid goods e~vfflce fUMhure and"fiztures. -' • ~
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<br />Consignee: •
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<br />1 understand tfiatm f1n81 cNarge.for eervice mu6t De based o~ rat~es t48t have been " ~
<br />appraed by the Puettc Utiiiry Commlssion and published in a taritf ragardless af anY Driver.
<br />ostima0e !or seMoe prwided to me Dy the ier. I U EAST/W D THAT AN EST1MnTE
<br />IS NCJL A FIRM 81Q 3 Z~~
<br />b ~,NE Epr3oas:
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