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~5128i.~99' 1~: ~5 5~~-297-2E~5 H~NN~'; h~1CELDOWNEY P~GE 05 <br />yOr~gon DQpsrtm~nt ol Transponetion <br />( am applying for payment fncurr@d in searchin9 For a rQplacement sile. <br /> RELOCATION <br />S1T~ SEARCH C~AIM <br />..~ <br /> <br />•Il~ NO . <br />Mnn~ <br />a.~,~, <br />N~~H~~~ <br />COV~r~ <br />t~v No <br />''L~~ <br />~ ~~ <br />H} <br />1 <br />~~ ~ <br />~~ <br />~ understand ihat 1 may be reimbursed for ihe acutal reasonable exQense in s88rChinQ for a replacement 8it~. not to <br />~KOSSh ct.OQO. ~ucn mxpens~e n+~y rna~ue. cee~e o1 transpertst+on, meal~, Iod91nD •wey from horr~~, and ths -~~~on~Ci~ <br />value o( lime ectua~ly spent In the search, Including !he faes ol real estata agents o~ real es(ate brokers, <br />AIf expenses claimed, except value ol the (lm9 actually spent in Ihe search, must be suDporied by rgce~pted bills, Payment <br />f~r rrdll~ driven may not excaed 20 Cenls p~r mfle. <br />Payment for the time actually spent in the search s~+a#t be based on tha appticabfe hQU~ly wage rate for the person(s) <br />conducUng tha ~~e~ch but may noi excesd 330 per hour, <br />DATQ MIL@5 ORl~/EN RATH ~fp <br />MIIE OAf~Y <br />CNAfiGE HOURS SaiNT R~-T~ OF PAY OR1tY <br />CW1RG8 M ~$ b <br />IOOQINO <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Subtotal oi Mllea e Char e9 S Subtotai~ E <br />This fs a certfiied statemenl 01 miles drtven, hourS spent. and other expenseg while searching for a replac!lment site. <br />Tobl Ctaim S ~QOQ,Oe <br />Comments to 9upport claim approval~ <br />Billing statement from Coldvell Banker _~~~1,~,~,~~ S;`~~ ~t~~ <br />s ~i004.~• e• ~ <br />Form 203 (7/95) <br />9!M S iqnaturi 71^ <br />Re~.~s+~~r= 3~qnswra fl~~Q <br />RELOCATI4N <br />SITE SEARCH CLAlM <br />