Laserfiche WebLink
~ <br />r~--- <br />Oregon Department of Transportation RELOCATION <br />RESIDENTIAL OCCUPANT INTERVIEW <br />^OWNER (~TENANT <br />Property Address ~~c~~ ~.Q.i~~~i ~Z _ <br />Date of Occupancy ~ Contract Rent d 7~ <br />Attach copy of rental agreement or rent receipt <br />Estimated Monthly Utility Costs: <br />Electricity ,~ Heat <br />Water Sewer <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°/a 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 DWELLIfVG: <br />REPORT OF PERSONAL INTERVIEW: <br />Right of Way Ag <br />Date <br />Form 101 (6/95) RELOCATION <br />RESIDENTIAL OCCUPANT INTERVIEW <br />