Financial- Ingle, Joshua (previous Tenant

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~,... Oregon Department of Transportafion Pay To: J ~~~~. ~ ~~~ ~ ~ / Mailing Address i O^ ~~ ~,1 ~~ ~ ~ c I L ~_ U L ~ v- 7s ClaimanYs Name RELOCATION SCHEDULE MOVE CLAIM Sedion Highway County FAP No. I am the displaced occupant of the dwelling at ~ ~' . My claim is based on a room count of ~ and is in the amount of -- . o. elect to move myself and receive an amount based on the number of rooms as establi ht of Way Agent at the time of negotiations. Number of 1 2,{. 3 4 Plus Rooms Unfurnished $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 reasonabie 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 efigible 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 orderiy. 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 eligibl for ayment of additional moving claims or utili reconnection costs. I vacated the premises on ~ ~ ~_ y_~ .a ,~~ „ ~~ aP 7 Room Count of~~ertified by: Inspection of the subject property was made on `~~~~r~d found to be vacant, clean, and orderly. I recommend that the schedule move pay~r ent of $~-a_ be released.~Q_. Comments to support approval: $ E. A. ~ 3 -t Reviewefs Signature Date ..r° ~i File No. Name Form 121 (1/97)