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m/o n u m e nt Fairview Bridge Replacement and Street Improvements: Relocation Plan <br />INTERVIEW ROTES (explain all special drwllinplhousohold circumstances, Inch►ding those noted on prays 31 1 <br />1. Ralaton- Spouse, Child, FoslsrChi'.d Paent Pager, Siding, AunyUncle, Ceusin_ Grandparent Parent In -Low. Sibling In-Lm, Other Relative. Roommerts <br />2. Ini❑mr: VMWUSda n. Social Sociirty0saWansion, Child SuppnrVkimony, INel1a*7ANF1AFO0, Family SubsidVIGdt. Business income, <br />InterecMvid9nds, Unempl Morken5 Comp, AF pay, EITC, Ceeh Income. Rene Reduction, Otw <br />j3. Lapel Shiluir Lkiknawn, QtzerlNatwal, LawU Other, NOT I-Awtul, Decline brinvide. <br />4. Owt&np- SFP Duplex. 3-Flex, 4-Pleb. Apatpent CorKWTownhorne. K3WVluf , Lloti Ie Hans. RV Otter <br />5. Loonr Fixed 1rScrWsae, Adjuslabre Nt ogeQe, tniaest Only. Fixed WLOC, AdusWe HELOC Ravoree l kxagam, Otter <br />I Claimant Name: <br />certify that all occupants have been ldentlfied above and that R11 #1formation <br />Provided for this survey is true and complete to the best of my knowledge. <br />0 a:e Signature <br />City Council 39 — 33 4/5/2022 <br />