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CM-2025-260 - 10/17/2025 CLAIM FOR ACTUAL MOVING EXPENSES "'-'� I.Name of Claimant(s) Parcel No: SPJPT LODGE 187 County:WILLIAMSON SPJST LODGE 187 Project:920 LUTHER PETERSON PLACE 0 Residence 0 Business ❑ Farm © Norprolit ❑Sign C]Other 2.Address of Property Acquired by Williamson County: 3.Address Moved To: 920 LUTHER PETERSON PLACE STORAGE/VARIOUS CHARITY ORGANIZATIONS/PERSONAL RESIDENSES Claimant's Telephone No.: 4.Occupancy of Property Acquired by Williamson County: 5.Distance Moved: Miles From(Date):1/1/05 I To(Date of Move): 7.Mover's Name and Address: 8/31/25 Self Move []Owner/Occupant ['Tenant 6.Controlling Dates Mo. Day Yr. a. First Offer in Negotiation d% 010 Ws 9.Amount of Claim: 2,260.00 b.Date Property Acquired Og ).{ 10L5 a. Moving Expenses c.Date Required to Move 08 31 2025 b. Reestablishment Expenses $ 8.Property Storage(attach explanation) From(Date): 'l'o(Date of Move): c. Searching Expenses $ Place Stored(Name and Address): d. Tangible Property Loss $ n/a e. Storage $ 10.Temporary Lodging(attach explanation) f I'emporary I.odttine From(Date): To(Date of Move): g. Total Amount S 2,260.00 I I All amounts shown in Block 9 were necessary and reasonable and arc supported by attached receipts. Payment of this claim is requested. (certify that I have not submitted any other claim for,or received reimbursement for,an item of expense in this claim,and that I will not accept reimbursement or compensation from any other source for any item of expense paid pursuant to this claim.I further certify that all property was moved and installed at the address shown in Block 3,above,in accordance with the invoices submitted and agreed terms of the move and that all information submitted herewith or included herein is true and correct -G 5 4C*1444.41 leImitt Dale of Claim Claimant Date of Claim I certify that I have examined this claim and substantiating documentation attached herewith and have found it to be true and correct and to conform with the applicable provisions of State law.All items arc considered to be necessary reasonable expenses and this claim is recommended for payment as follows: Amount of 2,260.00 aL2 Date lid ton Age tot ill2025 Date City of Round Rock 4897-6538-5330 eM -2025 --2 00 DATE: September 25,2025 TO: Lisa Dworaczyk Sheets and Crossfield FROM: Mike Knott Right of Way of Texas SUBJECT: Relocation—Request for Payment:Actual Cost Self-Move(Timesheets)—$2,260.00 Project/Parcel: 920 Luther Peterson Place—SPJST Lodge 187 Please process payment in the amount of$2,260.00 for an Actual Cost Self-Move based on attached timesheets documenting labor to pack, load, transport(including charity drops), unload, and return equipment for the displacement at SPJST Lodge 187. Following receipt of a signed addendum clarifying the prior use of the term "cleaning,"all timesheets were corrected to remove that wording. The revised timesheets now accurately reflect eligible moving activities only. However,the addendum still applies. Supporting Documentation Included Claim Form —Actual Cost Self-Move Certificate of Eligibility Release of Property IRS Form W-9 (SPJST Lodge 187) Signed Timesheets(one per person) with dates, start/stop times,task descriptions, totals, and stated hourly rates Copies of Checks showing payments to movers/participants Photos: pre-move,during move/charity drops, and vacancy Addendum clarifying the term"cleaning"as organizing/sorting/packing/moving(signed) Vacancy Verification Please let me know if any additional details or backup is needed to finalize this payment. CERTIFICATION OF ELIGIBILITY Project: 920 Luther Peterson Place Parcel: SPJST Lodge 187 Displacee: SPJST Lodge 187 Individuals, Families and Unincorporated Businesses or Farming Operations I certify that myself and any other party(ies)with a financial interest in this relocation assistance claim are either: Citizens or Nationals of the United States or 0 Aliens lawfully present in the United States * If art Alien lawfully present in the United States, supporting documentation will be required. Date: *pe, imam Date: Claimant Incorporated Business, Farm or Nonprofit Organizations I certify that I have signature authority for this entity and such entity is lawfully incorporated under the applicable state's laws and authorized to conduct business within the United States. �' Date: 9_01a-as Cla. nt Project: City of Round Rock Project No.: 920 Luther Peterson Place Parcel No.: SPJPT Lodge 187 County: Williamson RELEASE OF PROPERTY This is to notify the Condemning Authority in this case, City of Round Rock that SPJPT Lodge 187 has vacated the property located at 920 Luther Peterson PI, on 08/31/2025,and relinquish all rights to the property,real or personal,left at this address. �'. ,1 isplac ignature Displacee Signature Linda Johnson, President Rubie Volek,Treasurer Displacee Name, Printed Displacee Name, Printed Date Date nailer U$PLAc6E PERSON/H.PROPERTY ULF MOVE PROJECT s P 5 r ) C /5 7 ROADWAY PARCEL Nair"' j Hso14, PieesideNt- Dols Tttalt Tian sa>,..a This Prws.,I Ts -ff PAI _ cg,D83. !sl--l me i t.43---1f 9-bLe s 3 -A.5 moo`/.4 toe 1Ld1r1 Ae0Ae 12 5 - , 0.1?._442 Tab/Rows Q. Rex Per Hour : do Total Pav ey my tigroaxs `ont s. ruin strays b to d mn.et : B d PROJECT s 3 S 'lR IALfR0'lRr1/OdfMoY! RO1 DWAY PARCEL N.w., KQhn 1j'l m€yi` Tk �.,... ,►m.. ......I Na.s $- �teL io,`^!3Total Hours "3 Rate Nit Hour Co, TAWOry ;- 9y AN sIgnalwe aMylief*Vino sod hasty We show okra k bus sad toned 0 TOIESREE��T,O$SPLACEE PERSONAL PROPERTYEL SF MOVE PROJECT 5 p 3, T As)cf`9 o f 7 ROADWAY PARCEL /i G LII [[11 I I Mande: --r G V` Data Ti k 'Ulna Started Time Finished Total Hood 8 --�f' �1`/1 i,N�3 e 5/u/i�'2 Cs� Total Hours it' Rate Per Hour SZOO Total Pay 42,00 Cy 0 By"ry clgralt!CNA'I I M ewe rie bee and halide +e le true and corned SlonaturatN �� TMESMEZT o1 PLACEe hERSOMAL PROPERTY MR EWER sP-$ T Les d9e [5.7 PARCEL Mama: Ze r j-f elk Dab Teak Mao stated Mao Plalabed T.e&Mora rvisitos /..i_D g4-114) _ (.0 c5 09 1/hi 2i N 4 .O ' . p I LC . . 1//.AwIi05 tYta.rh 2 -15 r,.l,i_I-41:,� /h 11/l it c '1 :P , `1e-' t/h.tt-fits Say'tc 0k. '•4_k 5 3 r ti Total Moon 2 Rate Pr Hour I 'Z.,Tatty►ay s.a'*.O a 0, By my amity Mal n+w ena uEors mn convict . tempest. v p w.�pa 04 %414 nw pa wua wa uw mtempest.w.•44.40 ♦ Asa Mat p nCZ I Jn°H Aed awb 11 �� ��• 07,A 1,e4 /r E '75.7 a (is MOON ow LL eiramS+rMt Ma4l ,I 'e'o /ar Q1 a ra/9:swam 'TWANd AYA OW011 MON 3139 AlaidOYd WNOsitad ThOV 1dg101348n1 T111ESNEET EE PERSONAL PROPERTY SELF- mum' s P 3 5 T �D7 i q'7 ROADWAY PARCEL �``y, Hamm ate$ \fir. {W • ,1 tk.gtk, Dale Task Time Started Time FialSMed Total News $ ,1. o . —. 1 o wt Trot,s1\ 1; 15 a'.15 1 .%- 6o1; Wo. — rc s k ( so .2..:30 1 I I Total Naar* L,p Rate Per Hour !� o J7 Total Pay $ (/ Ely my 61gna¢.re bel 1 Mal the Om and. fy Mee above* and Slgrutiore: 4A.1 -,- ' UNIv.Y.w Wuw Pa wW ti•ogi L00,04p i 41004 PR OUP•41•QI A0M91 NAMW.'as!,u 00.0$. ...A., , „-74 JfOH Ad am Oil 41 L- moos tem a,�JN - S7"7/`°' & b d / y O 7 Jv / �,Cv / 4? A / --' L. s'1 1 v7a .L�r7 d �f � ,{r '41rffQ7/?' /� 0 PI- �-v �r `7 '/'', N I�M1_P�1►U 41210LL M *W4 NA / � '`9 l3OMYd n— AVMOVOtl 4 /'O�/ 67 ) / [ J 103fOb0 2ACHN�i139 A1b7dOlidlrllbliFa/>>iJh�1�"etta1 3HINIPRy c� e TRIESilEET OISPLACEE PERSONAL PROPERTY SELF MOVE PROJECT 5 P.� sT lq ROADWAY : . . L . • Data O Teak Time stated Time Finished TOM!Hour C, 1e r ‘t4 --lc-i 1 Total Hours p O Bate Per Hour s a.- ;? Total Pay s / d O By se signature q�p�'I Ya.t tha Ore and . rely shwa above taw and talW r(p O, ...-� Signature: l%•u tR - matorm..Rov�rT SELF roue PROACT 5r 5 ' ' ROADWAY DWAY Hoar OW. , raft...... Vint MON raw""'w1 $ 7 OW clocu .1-.--',A5, Re move L -eh gpin Y- $-)b 54-4( 1 wn Went/ ere 2 P'11 j 4- 1'7 /fir e. Qmax --eg#d ye feu 3 I ( reed MOWS I 042 0p Total Pig •1 d.Total M.ry.yt.W I i*j rlt d.Nnfe.wl.*us.d= al TVrea+EETOWLS=MASON&FRcrIFItr SELF rora .RAT 5f� 5T ,'M-/L 14 7 NOM N.m.t -p&p/ 0;n a�. Dia Tart ,lwsiWl.. urns FbSolost TotalIMem 2- 7 l:Lcl oICCa►1t-, cl 77 7--15 A �,:�m g�,r 4�3 /0 c X �,�-1�` uc-6)s 4-� 2�,n• 60 P•41- 44/D ,` R o fin UP rf .;2.1)4, gip, -3 • C i e CT e •-(/ ; Ntf 57 ' -LP s 11 MM Noan / 1 Rate Par Hour f try P WON . M ay W� nr,a.Ins.aMuWnMs lbws rw aroco coma ,�� 4 RIGHT OF WAY OF TEXAS, LLC 3411 SAM BASS ROAD, ROUND ROCK,TEXAS 78681 (0)(512)372.6220 Addendum to Timesheets—SPJST Lodge 187 (920 Luther Peterson Place) I, Linda Johnson, President of SPJST Lodge 187, hereby clarify that the word "cleaning", as listed on certain timesheets submitted for relocation reimbursement,does not refer to janitorial or housekeeping services. Instead, the term "cleaning" was used to describe activities that are eligible for reimbursement as moving expenses,including: • Organizing and sorting personal property, • Packing items, • Moving items to the charity center,to members'homes,or to disposal. These tasks were part of the personal property relocation associated with displacement from Parcel SPJST Lodge 187 and are submitted as reimbursable moving activities under the Relocation Assistance Program. Signed: PAP -rd� -SfSST �t'0&ge/N 2 Linda Johhns° ,P t—SPJST Lodge 187 Date: / ' —f0 9/21/25,10:07 AM AT&T Yahoo Mail-de 15caeon of Tlmseheet Entries—SPJST Lodge 187 Relocaton Clem Clarification of Timesheet Entries—SPJST Lodge 187 Relocation Claim From: Mike Knott(mike.knott@rowtx.com) To: Cc: dannyjackson@rowbc.com;sam.nassour@rowbc.com Date: Friday,September 19,2025 at 10:25 AM CDT Good Morning,Linda, We received and reviewed the timesheets that were submitted.I wanted to follow up to clarify the use of the word"deaning"that appears as a line Item on several of the sheets. As you are aware,and as we discussed by phone yesterday,the County cannot reimburse for cleaning. Reimbursement is limited to actual moving expenses only. During our conversation,you explained that what was written as"cleaning"actually referred to organizing, sorting,packing,and moving items—including those taken to the charity center,to members' homes,or for disposal. I'm writing to confirm this understanding in writing. Could you please clarify that the word"cleaning"on the timesheets should be interpreted as these reimbursable moving activities,and not literal janitorial cleaning? Thank you,and once I have your confirmation, I'll be able to proceed with processing the claim. Best regards, Mike Knott Right of Way Texas,LLC 3411 Sam Bass Road Round Rock,Texas 78681 512-903-5083 cell Mit Timesheet Addendum SPJPT Lodge 187.doc 31 kB abouttianlc 1/1 S. nrii T rH naT w SPJST LODGE ACCOUNT 4476 LODGE 187 88-78/1119 R Box Ro81ck, 9- 2 3—2 D 2S- DATE Round Roock TX 78681 daltrARMR PAY TO THE ORDER OF �(J . JL I $ )� QP %4 , 4.14k-4dAgl-44_ /7/17tie " ✓��.��J CD DOLLARS A REGIONS - ap SPJST LODGE ACCOUNT 4477 LODGE 187 PO Box 1181 8&78h119 Round Rock,DC 78681 / -p� —d'V DATE �CNF�CK�Mq� Y ORPAO TH E Q l °a OE TROf I�GT4l� $ p 0 C� ✓K O�/ - _ —DOLLARS A REGIONS FOR /n O- +y _ • K w`;-- -- - N SPJST LODGE ACCOUNT 4478 LODGE 187 PO Box 1181 _ 88-78/1 119 Round Rock,TX 78681 I 013-,207.ATE ORDER JP' , /' C r Qt,) DOLLARS A e » REGIONS n FOR *a id,o�,K. M1d'lt- - r SPJST LODGE ACCOUNT 4479 • LODGE 187 ea 7w1,19 PO Boot / `a2 g- IO.ZY`DATE Round Rock,TX 78681 line9NO! ORDER OF E ,MY er0 TO $ O REGIONS FORhurvii/4k _ . SPJST LODGE ACCOUNT 4480 LODGE 187 PO Box 1181 Q OR-T'"s Round Rock,TX 78681 ! �� `7"-5DATE PAY TO THE V ORDER OF I � � � pp1-0-1),76 Sep) p�Y1,LQ� (/h.((/L�O� DOLLARS a :rt." REGIONS • FOR SPJST LODGE ACCOUNT 4481 LODGE 187 PO Box 1181 _��-4 a& 1119 Round Rock,TX 78681 DAT E aftikcf.f,FE! PAY TR FE I �D �O /y44 DOLLARS l EGIONS � _ /� FOR r 2 • SPJST LODGE ACCOUNT 4482 LODGE 187 PO Box 1181 es-Ten119 Round Rock TX 78681 9--, 3-�ZS DATE PAY TO THE � ��QQ[[�ORDER OF I $ Fa IS • 11715 ei �/1tG r 0.6 DOLLARS a REGIOyNS ,,/ • 1/ FOR b�1E�Est • r • :.`�i',—.;rTi.' "'_. -@- €'.� ,..r•. ' ro.i"+ ''S' `:�.=: f _ ,_ _ - SPJST LODGE ACCOUNT 4483 LODGE 187 PO Box 1181 ¢—a 3'-�OZ$� 88.711119 Round Rods,TX 78681 DATE PAY TO TH ORDER OF E V 1254. Kdf4 /�Ci �-/-u OG j) � U � $ /6 D — `i�L� La- .4, \ •/i DD- DOLLARS a rd. REGIONS / FOR ,°M ��� -ar[_ v It • 1 r Ne SPJST LODGE ACCOUNT LODGE 187 4484 PO Box 1181 �y 88-T811119 Round Rock,TX 78681 9—O 3- 2OJ DATE PAY TO THE U 0� ORDER OF tIti1P ✓ 'L rob DOLLARS MI REGIONS FoRLLIId• Jk �� r r.111.111.11.1111111111. SPJST LODGE ACCOUNT LODGE 187 4485 PO Box 1181 Round Rods,TX 786811 7.e�- e�Tam1e -1. �+GJ DATE PAY TO THE ORDER OF c Alf4- .' if4-11 4:114L 6 DOI,ARS la w e. orW REGIONS • FO de V '� V 44 am-a�. Vacancy Verification Project: 920 Luther Peterson Place Parcel: SPJST Lodge 187 I, Mike Knott, with Right of Way of Texas, hereby verify that the property located at: 920 Luther Peterson Place-SP1ST Lodge 187 has been inspected and is confirmed to be vacant. All personal property has been removed in connection with the relocation, and the site is no longer occupied by the displacee. Inspector: Mike Knott, Sr. Right of Way Agent Right of Way of Texas Date of Verification: `� 12312A2-‹ Signature: //1/(xit42.41 -.•/0