04-13-11 Council Agenda - Laserfiche WebLink

Home Browse Search

MOVING COSTS CLAIM FORM Advance Claim X Final Claim Name (Payee) IBC Sales Corporation Tax I.D. Dist. N/A Artemis S P N/A Parcel N/A CS N/A CID N/A Fed No. N/A County Ramsey Prop Owner IBC Sales Corporation 2404 Rice Street City /State /Zip Little Canada, MN 55113 Type of Acquisition: Direct Purchase X ED City /State /Zip 1213 C iff Road East, Bumsville, MN City /State /Zip 5130 Winnetka Avenue, New Hope, MN Approved Amount $ 12,910.48 Approved By Approved By Jon W. Morphew Relocation Manager Date Application Approved April 7, 2011 Mail Check to: Name MC Sales Corporation C/O Barbara M. Ross Address Best & Flanagan, LLP 225 South Sixth Street, Suite 4000 City /State /Zip Minneapolis, MN 55402 w& VENDOR NUMBER: MOVING COSTS A. Non - Residential Moving Costs by Bid /Estimate B Non - Residential Moving Costs by Actual Cost C. Non - Residential Searching Expenses (Max. $2,500) D. TOTAL MOVING COSTS CLAIMED $9,551.50 $3,231.23 $127.75 $12,910.48 Residency Certification: I attest, under penalty of perjury, that myself and /or members of this partnership, association or corporation are lawfully citizens of United States or aliens lawfully admitted for residency and authorized to conduct business in the United States. I, the undersigned, do hereby certify that the above information is true and correct, and that any receipts or statements attached hereto accurately represent the expenses incurred I further certify that I have not submitted any other claim for reimbursement of, or received compensation for, any expense in connection with this claim. 1 understand that falsification of any portion of this claim will result in its denial. MAIL CLAIM TO: Schnitker Law Office, P.A. Date 1330 818` Avenue NE Name (print) Spring Lake Park, MN 55432 Signature Telephone 5