LA 9.23.05 Courthouse Street Lane R. Ludington

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' RELOCATION ` °°"'"~Jregon Department of Transportation FIXED PAYMENT ELIGIBILITY APPLICATION AND CLAiM Name of Displaced Organization Ftle No. Lane Auto Imports Name Mailing Address 703 East Broadway ~ 0~(~~0 Eugene, OR 97401 ~ .~.f d2 section H~y~y ~ °VP"e" lane Ludington Telephone Number. 541-687-0596 541.344-6591 (faX) county FAP No. ®Business ? Farm ?Ncn-Profit I hereby apply for eligibility determination for a fixed payment in lieu of reimbursement for all other moving and related costs and expenses. In accorcJance with ORS 281.070 1 have attached state income tax returns for confidential use for audit to determine the payment authorized. ®I am the owner of the above business, farm operation, or non-profit organization and that this business, farm, or non-profit organization is lawfu{ly located on the real property from which my personal property will be required to be moved. This business , farm, or non-profit organization has been in continuous operation since I~Ir~ t!P vv~h~ t2. t Y7 BUSINESS ® This business cannot be relocated without a substantial loss of its existing patronage. (A business is assumed to meet this test unless the Agency determines that it will not suffer a substantial loss of its existing patronage). ® This business is not part of a commercial enterprise having more than three other entities which are not being acquired by the agency, and which are under the same ownership and engaged in the same or I! similar business activities. ® This business had annual gross receipts of at least $5,000 or had average annual earnings of at ieast $1,000; or contributed at least one third of the operator's average annual net income from all sources, during the two taxable years prior to displacement. ® The business is not operated at a displacement dwelling or site solely for the purpose of renting such dweAing or site to others. FARM OPERATION rt of the land resulted in the displacement of the farm operation, or th land or a The a uisition of e p ? cq ? The acquisition caused a substantial change in the nature of the farm operation. NON-PROFIT ORGANIZATION ? The organization cannot be relocated without a substantial loss of existing patronage -membership or clientele. (A nonprofit organization is assumed to meet this test, unless the Agency demonstrates othenrv' ' ~ I ~ ~ Applicant Titie date To the best o knowledge, this applicant meets the criteria necessary to qualify for the fixed payment in the amount of $ 734-36 Q3 i'1/0v;