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~5~2~;'199r 10:23 5~~-297-28~5 <br />. , , <br />. ~ <br />H~NN~ P~iCELD04~!NEV' <br />`~r.I` <br />CLAIM FOR EXPENSFS TO SEARCH F08 gEPLA,CEMENT SrI`E <br />I bereby apply for payraent for the eapensea incvrred in searching for a roplaccment site. <br />IT IS UNDERSTOOD: <br />P~6E 04 <br />ASeucy: <br />Projeat: <br />File ~: <br />17~e owaer af a displaced business, farm, siga or NPO may be reimbursed for chc actual ressonable ezpenae in <br />searching for a nplaccment site, not to exeeed S1,OOQ. Such c~penses may indude costs of transportation, meals, <br />lodging away from home, aad the reasonable value of time aetually spen~ in scarch, including the fees of real estatc <br />agmts or rcal ~state brokc~s. <br />All ezpenses claimed, ezcept value of time actually spent in search, including the fees of rcal cstatc ag~nts ar real <br />estate brokers must be supported by receipted bills. PaymeAt for miles driven may aot cacccd 20 cents per mile. <br />Payment for dme actva~ly spent In search shall bc based on the app6cable honrly wage ratc for [hc person(s) <br />canductin~ thc scuch but may not cxccod S30 pcr bour. <br />Date Miles <br />Driven Rate per <br />Mile Daily <br />C~arge Hours <br />Spent Rato of <br />Pay Daily <br />Charge Meels and <br />Lodg}ng <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Sl~btotsl of Mileagc Chargz Subtotal of Hour(y Charges <br />This is a cettified stattment of miles drivea, hours spent aad other exgenses while soarr.hing for a replacement site <br />Total Claim S Date <br />G7 aim <br />Addrose <br />Se~na6 for Ra~a~ement Sife Hamr. Mc$Jdo~a~y !t Ar~r~oefaw (303) 297-9588 <br />Appcw~l • Nejvoauon • Rclocaooa • 3tMie» <br />