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{; r ..• 41111V <br />Owner <br />Name (P e) Ann bake <br />Q Tenant <br />F1 Reoelpted Beep • Room Ibex <br />Dist _ Artemis $,P_ Parcel <br />Type of unit <br />.�. r <br />C.S. C.ID. <br />. <br />wn <br />Fed No. . <br />Prop. Owner Ann P <br />* <br />Total Rooms <br />Prop. Address t *f • E ' , <br />" /►r <br />City/Suet/Zip ,Pointy. MN <br />❑ Fkenished <br />❑ Unfurreplwd <br />ED <br />Type of Acquisition: ❑ Direct Purchase • <br />10/17/2006 15:29 9524484676 <br />89/2/2006 10 :3B 952dd84576 <br />TP.26162 (21O0) <br />Name of Mover Self Move <br />Address <br />NAIL C L IIa TO: <br />WILSON DEVELOPMENT SERVICES <br />610 CHESTNUT ST SiE 200 <br />CHASKA, MN 55318 <br />-16- t T 'd 9L9i liti&2S6: °l <br />lininneecte Department of Transportation <br />RESIDENTIAL MOVING COSTS CLAIM <br />'IMPORTANT: PROMPTLY SUBMIT AFTER MOVE" <br />WILSf1t1 DEVELOPMENT PAGE 82 <br />❑ Advance Clain © Partial Claire <br />ak <br />City <br />WILSON DEVELOPMENT PAGE 03 <br />ei IF <br />Approved Amount I 02994 , ,� <br />APPr+""d y _ u' VQk L <br />Approved By <br />Relocation Manager <br />Pete Application A . ved <br />Mill Check to: <br />Name <br />Date of Move <br />I- 1 6 <br />r.. ' <br />Date G <br />Nemo (Only L)� <br />Signature c� <br />TelephOrie 74' <br />VI Final Claim <br />Ad s i -�/ MW <br />L (-4—crW--; ,re 2 .4 2 -;: 41 4f <br />t.ityISlalalZlp s <br />:Irr i 1,- ul <br />� I; I�iT;: �' 7 f`t�ArrwG� �l��� 'il":!� <br />i <br />Address Went out of Bushes/ <br />City Stag <br />Residency Codification: I attest, under penelty of perjury, that myself and my family. are lawful citizens of tie United States. or <br />aliens: lawfully admitted for residence in the United Stetee. <br />I. tto undersigneci, do hereby certify gist the above information Is correct, and that any moves' receipb3 or statements careened <br />hereto accurately represent the expanses mourned. I further certify that I have not submittal arty other moving claim for <br />reimbursement of, or received compensation for, »ny expense in connection with thaw claim. I understand thotfatsiticabmn of <br />any portion of this claim will result in its denial. <br />:w 99 :80 900E- 6a-d35 <br />Owner <br />Q Tenant <br />F1 Reoelpted Beep • Room Ibex <br />Type of unit <br />It Room Basle <br />❑ Apartment <br />Q Mouse <br />Other <br />* <br />Total Rooms <br />Basement Count <br />Garage Count <br />Miscellaneous Count <br />❑ Fkenished <br />❑ Unfurreplwd <br />Grand Total u.1,u <br />10/17/2006 15:29 9524484676 <br />89/2/2006 10 :3B 952dd84576 <br />TP.26162 (21O0) <br />Name of Mover Self Move <br />Address <br />NAIL C L IIa TO: <br />WILSON DEVELOPMENT SERVICES <br />610 CHESTNUT ST SiE 200 <br />CHASKA, MN 55318 <br />-16- t T 'd 9L9i liti&2S6: °l <br />lininneecte Department of Transportation <br />RESIDENTIAL MOVING COSTS CLAIM <br />'IMPORTANT: PROMPTLY SUBMIT AFTER MOVE" <br />WILSf1t1 DEVELOPMENT PAGE 82 <br />❑ Advance Clain © Partial Claire <br />ak <br />City <br />WILSON DEVELOPMENT PAGE 03 <br />ei IF <br />Approved Amount I 02994 , ,� <br />APPr+""d y _ u' VQk L <br />Approved By <br />Relocation Manager <br />Pete Application A . ved <br />Mill Check to: <br />Name <br />Date of Move <br />I- 1 6 <br />r.. ' <br />Date G <br />Nemo (Only L)� <br />Signature c� <br />TelephOrie 74' <br />VI Final Claim <br />Ad s i -�/ MW <br />L (-4—crW--; ,re 2 .4 2 -;: 41 4f <br />t.ityISlalalZlp s <br />:Irr i 1,- ul <br />� I; I�iT;: �' 7 f`t�ArrwG� �l��� 'il":!� <br />i <br />Address Went out of Bushes/ <br />City Stag <br />Residency Codification: I attest, under penelty of perjury, that myself and my family. are lawful citizens of tie United States. or <br />aliens: lawfully admitted for residence in the United Stetee. <br />I. tto undersigneci, do hereby certify gist the above information Is correct, and that any moves' receipb3 or statements careened <br />hereto accurately represent the expanses mourned. I further certify that I have not submittal arty other moving claim for <br />reimbursement of, or received compensation for, »ny expense in connection with thaw claim. I understand thotfatsiticabmn of <br />any portion of this claim will result in its denial. <br />:w 99 :80 900E- 6a-d35 <br />