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• CT 4IM FOR ACTUAL MOVING EXPFNSE <br />r„~WELLING, BUSINFSS, OR FAA-,,,,,~ <br />A=rocY: <br />~~ <br />Pik /~ <br />, I lureby makr. appllcation for actua! rnoving rxpensc a~ising frorr~ my rriov~ nutitoriZed by Marion Counry. <br />Claimaat: <br />Addr~ss movad from: Phone #: <br />Distance~ Movad: Date of Move: <br />f Mover Name and address: <br />Phone ~-: Total amount of claim: S <br />I hereby cert{fy that the foregoing cloim !a just and rnrr~c.t, that rhe amo~nr claimed is legally d~c~, qfter <br />allowJ~g all just e~edits and thal no pa~t oj same har be,en paid. <br />Date <br />Claimant's Si~naturt <br />Clai~r-ant's Signature <br />I Addrese: <br />Inapection Report <br />Inspaction of tha subjact property waR mecle on <br />I orderly. I recommand that movin~ expanec allowanca of S <br />' Occupant'e naw mailing addresr is: <br />II 7'alaphona: <br />Date <br />Agent <br />miles I <br />su~d found vacant, clasn, and <br />be released. <br />Dis[ancc Movacl: <br />Hanne, McEldowney & Associatcs (503) 297-9388 <br />