Financial- Heinle, Eric (Previous Tenant)

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~ Oregon Department of Transportation /'/ ~ Pay To: I ~ ~ Mailing Address ~ I I o ~~ ~~~ L SQ ~~~ d ClaimanYs Name ~~ e • ~ I ~ / ~ RELOCATION SCHEDULE MOVE CLAIM File No. Name Seaion Highway County FAP No. I am the displaced occupant of the dwelling at ~ r~lll.l~ ~~ . My claim is based on a room count of ' and is in the amount of $ SSC~,~ . I elect to move myself and receive an amount based on the number of rooms as established by the Right of Way Agent at the time of negotiations. Number of 1 2~ 3 4 Plus Rooms Unfumished $300 $500~ $700 $825 $125 for each (Relocatee additional room owns furniture) Furnished: $275 for the first room plus $40 for each additional room (Relocatee does not own furniture) Exceptions: 1. Person whose residential move is performed by the agency receives $50. 2. Move of a mobile home from the displacement site, actual cost. A reasonable amount may be added for packing and securing personal property for the move at the agency's discretion. 3. Occupant of a dormitory receives $50. 4. Non-occupants of the dwelling, such as landlords, are not eligible for the schedule move. I understand that, prior to this moving payment being made by the Oregon Department of Transportation, this dwelling must be inspected by a Right of Way Agent and found to be vacant, clean and orderly. I also understand that this schedule move agreement is an alternative to a payment for actual moving costs and related expenses and that I will not be eligible for payment of additional moving claims or utility reconnection costs. I vacated the premises on y..~ iman g~a ure a e Room Count of ~certified by: Inspection of the subject property was made on `'~~~.~nd found to be vacant, clean, and orderly. I recommend that the schedule move payryf~nt of $~~b~eleased.~ ~ ~ Comments to support approval: $ E. A. Reviewers Signaturo Date Form 121 (1/97)