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Preferred'replaeement site atsnbutes <br />Re,cm5m ana: PmFeny access M daaq: <br />ZcnG.3-.yTe d use: Trak acwss: <br />Leasef punhase: FreeMysIa,.!eria's pspmiy. <br />2uHmg vzarzywt Wbictranapadaccess: <br />Sin3le'mw<:stvy kakirg: Pedestdm acvss <br />CNonnce'hei3ht Fading spaces <br />Laby.udsae: Shipp igImovOng!ype: <br />Spedal utTry needs: DamograFhic nsads: <br />In:eaet service roads: TnfSc count reeds: <br />Rmcisa'arinammmi cbc Yn3uyneeds: <br />Specific concerns and anticipated move challenges <br />List of any idenfified replacement sides <br />Addreaa Bldg eme Lot size Leaseamount Status Brokerinfo <br />1 <br />2 <br />3 <br />AOOITIONAL INTERVIEW NOTES (explain allspecial circumstances, including those noted above) <br />1.URA tusmese type: 13113111x8. Farm, Nor.-Profit <br />z WC tCnIn633 type: Agr[MItma. tnauatdal oFM. Rahn Sakro Retail service. specialFlnpcsa(debucodex) <br />3. PI316a31CIM! SpaCb[W- Adomey.AccomdriL Bmkar. MC)" P=n3. Cardfactcc <br />A. mbmte iew aSL CAICTI. fitw, sata&te. otlwr <br />1 certify that ail information in this survey is true and complete to the best ormy knowledge. <br />The information contained herein shall be treated confidential to the extent permitted by law. <br />COimant Noma: Date: SignatLm- <br />G S?ECi_012 a.eran4 Pa.^•:.c A Ml +, a!`.. lcy'tml <br />75B-44 <br />