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05i'20i'199~ 10:2~ 5~~-29~-28~5 H~NN~ I~~ICELD04~INEY P~GE 05 <br />~ <br />~..~ <br />ASaacy: <br />Projoct: <br />F(k r: <br />COMMON CARRiER, BUSINESS, FARM OR NPO MOVE APPLICATION <br />I hereby makc applicatian for rclocatioa paymcnt for aetual rensonable moving coata. It is understood ~hat paymeut usually canaot <br />be made for moving costs for more tban SO miles. <br />INSTRUCIIONS: You may choose any rnmmon earrier (Publlc Utility Commission l~ceused movcr} to suDmlt an <br />estimate of costs. Atter seloctIng a mover, contaet him and explun that you ate ~a be relocated <br />by a highwsy project. C3ive him your addtess aad ask him to visit your location to prepuc an <br />estimate of cost and to complctc this form. When thid toem i~ fully completed, Rturn it in t6e <br />envelope provided. <br />Applicmt's name: <br />O:i~nal Address: <br />New Addtess: <br />Pbone: <br />Phone: <br />By my signaturc I cestify that: <br />1. TLe lisDng ( on reverse side) of persoaal propcny to bo moved is cumplete and accurate, to t~e besc of my <br />knowledge aad includes no items whlc~ are not now on the premises. <br />2. I have selected the moving company shown below to haadle my moving. <br />3. I undetstaad that paymesnt wlll be made directly to tLe moving compaay. <br />4. I wlll leave the premi~es clean ,nd orderly. <br />Si~atun Date <br />Nsmo of moving cosipany: <br />Address of moving company: <br />Followtag is our estimate of cost of moving furniture aad per~son~3 property at the above addtess. Estimate is based on t~o new <br />address (terminal) if it is known. The estimate is based on a standard moving cost and may include watdrobe service, packing or <br />any other special haadling. <br />Esdmatcd Moving costs E <br />~ Basod on aesumed move of SO miles dis~ancx <br />C] Bascd on move to <br />By <br />(fnr moving rnmpany) <br />Inspcction of the subjeet property was mafle and was found vacant, <br />claa a~d orderly. "IhE relocatec has moved to <br />/3gept <br />Datc <br />p8~ 1 Hanna, McEldowacy & Associatcs (303} 297-9388 <br />