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C,,..A i~4i FOR COST TO REESTABLI~~f <br />~ ~ <br />COUNTY GOYERNIKENT <br />Pay To: KARION COONTY Agency: <br />Add[ess: 100 HIGH STREET NE P[ojcci: <br />City/State: SALEM. OREGON 97301 Flle 1~: <br />Claimant's Name: MARION COUNTY <br />YlRIOUS DEPARTIiENTS 10 TOTAL) <br />I HEREBY CLAIM T'HE FULL4WIl~JG COSTS ACTUALI.Y INCURRED Q~I jtELOCATIIYG ANp REESTABLISHING MY <br />SMAI.L BUSINFSS, FARM OR NON•PROFIT ORGANI7.ATION. I HAVE ATTAC$ED ACTUAL RECEIYTS TQ VERI~'Y <br />MY EXPfiNSES. I HAVE INCLLIDED WRtTTEN SUPPORT OF AGL ESTIMAT'E5. <br />MY CLAIM IS HASED ON THE FOLLOWINC3: <br />Repdia or improvcmcnts to the repl~oement praperty u cequired by Federal, Statc or locat law, <br />codt or ordinaucc. <br />Modificasions to tho roplaocment proporty to accommodato tho business operation or makc the <br />npluemont strudures suitable foc conducvng the busiaess. <br />Coastruction aad iasttllation coets for exterior sigaing to sdvertise thc busincss. <br />Pcovi~ion of utilities from right of way io Improvementa oa thc replaccment site. <br />Rsdeaoration or replacem~nt of soiled or worn surfaces at the replacement sitt, auch as paiat, <br />pmdling or carpeting_ <br />Licenses, fees aad pormi[s when nat paid as par~ of moving oxpenses. <br />Advortiaement af replacemont location. <br />Professional setvic,~s in connedion ~+itb the purchsse or lease of a rep(actment sitt. <br />Esdmated increased costs of operation during t~e first 2 years at the replacement site for <br />such items zs: <br />A. Le~tse or reaial chuges <br />B. Peraonal or roal propcny taxcs <br />C. Insutaace premiums <br />D. Utility chuges. exe~uding impact feos <br />Impact fct ar oao timc ~sessmonts for ~aticipat~d heavy ntility usage. <br />Ot~er (explaia) TOTAL E%PENSE <br />RESTABLISH1iENT MA%IMUM ALLOWED <br />'i' pj, E NT N EXCEED 510~000 ~~' <br />/~~~ ~ ~ 9 <br />'maut atute Due <br />ELYN li LYON. PROPERTX MANAGER. IYI~RION GOUNTY _,_ <br />Commonts to support claim: <br />AGENCY APPROVAL <br />Amount Approved: <br />Reloudon A~ent Date .4~ency Repceaenuuve <br />S 172.419.30 <br />S <br />~ <br />S <br />S <br />S 225~777-72 <br />S <br />S 430,197.78 <br />S 92,527.76 <br />8 <br />92,527.76 <br />D ate <br />