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Oregon Department of Transportatior~ <br />I am applying for payment incurred in sea~ching for a repiacement site. <br />'~" REIOCATION <br />SITE SEARCH C~AIM <br />I understand that I may be reimbursed for the acutal reasonable expense in searching for a replacement site, not to <br />exceed 51,000. Such expenses may include costs of transportatlon, meals, todging away from homa, and the reasonable <br />value of time actually spent in the search, including the fees of real estate agents or real estate brokers. <br />All expenses claimed, except value of the time actually spent in the search, must be supported by receipted bills. Payment <br />for miles driven may not exceed 20 cents per mile. <br />Payment For the time actually spent in the search shall be based on the applicable hourly wage rate for the person(s) <br />conducting the search but may not exceed 330 per hour. ' <br />DATE MIIES DRIVEN RATE PER <br />MIIE DAILY <br />CNARGE HOURS SPENT RATH OF PAY DAILY <br />CHARGE • MEA(.S 8 <br />LOOOINO <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Subtotal of Milea e Char es $ Subtotals $ <br />This is a certified statement oF miles driven, hours spent, and other expenses while searching for a replacement site. <br />Total Claim $ 1~ ~pp . p~ <br />Comments to support claim approval: <br />J C C <br />_ Billin~ statement from Coldwell Banker - Replacement site search <br />$ 1,0OO.Ob E a ,- <br />Reviewe~s S~gna~ure Oa~e <br />Form 203 (7I95) <br />RELOCATION <br />SITE SEARCH CLAIM <br />