Leasehold Determination - NCDOT



LEASEHOLD DETERMINATIONTIP/Parcel No. FORMTEXT ?????WBS : FORMTEXT ?????County: FORMTEXT ?????Description: FORMTEXT ?????Claim of: FORMTEXT ?????Billboard Owner: FORMTEXT ?????Company Representative: FORMTEXT ?????Title: FORMTEXT ?????Address: FORMTEXT ?????DOT Permit Issued To: FORMTEXT ?????Permit No.: FORMTEXT ?????Logo: (located on billboard) FORMTEXT ?????In Billboard Owner’s Name? FORMTEXT ????In Property Owner’s Name? FORMTEXT ?????Listed for taxes: Yes FORMCHECKBOX No FORMCHECKBOX Listed in the Name of FORMTEXT ?????In Tax Year FORMTEXT ?????Listed as: Personal Property? FORMTEXT ?????Real Property? FORMTEXT ?????Lease:Recorded FORMTEXT ???Deed Book FORMTEXT ?????Page FORMTEXT ?????Copy of: Lease FORMTEXT ??Memorandum of Lease FORMTEXT ??Does the Lease contain language or provisions such as follows:the right to remove the billboard (a) by the owner? FORMCHECKBOX (b) at any time? FORMCHECKBOX (c) within a stated period? FORMCHECKBOX (d) at the end of the lease? FORMCHECKBOX (e) upon any event, such as damage, condemnation, etc.? FORMCHECKBOX the billboard is called a trade fixture? FORMCHECKBOX the billboard will remain the personal property of the lessee? FORMCHECKBOX describes a definite area or site? FORMCHECKBOX term of lease FORMCHECKBOX FORMTEXT ?????Years:beginning date FORMTEXT ?????terminable by property owner? FORMCHECKBOX renewal clause? FORMCHECKBOX length FORMTEXT ?????how is rent paid?MonthAnnually (circle one)Other FORMTEXT ?????Contacted NCDOT Outdoor Advertising Coordinator for more information? FORMCHECKBOX From DOT’s permit, the billboard is: Conforming? FORMCHECKBOX Nonconforming? FORMCHECKBOX Is there a local ordinance that will prevent the billboard from being located to the remaining or adjacent property FORMTEXT ?????R/W Schedule Date to File Misc. Improvements FORMTEXT ?????Date right of way acquired from the property owner FORMTEXT ?????Date: FORMTEXT ?????Submitted by: FORMTEXT ?????Telephone Number: FORMTEXT ?????BELOW TO BE COMPLETED BY AREA NEGOTIATOR FORMCHECKBOX The property upon which the billboard is located will be subject to a leasehold interest as of the date the property must be acquired by condemnation. Appraisal of leasehold interest is necessary only if billboard cannot relocated/reinstalled on same property. FORMCHECKBOX The property on which the billboard is located does not appear to be subject to a valid lease. Give proper notification to the billboard owner for removal from the proposed right of way after DOT’s acquisition has been completed. FORMCHECKBOX The property on which the billboard is located is subject to a lease which will terminate prior to the date the underlying land must be acquired by condemnation (or which lease can be terminated prior to the date by the lessor/property owner upon giving proper notice). Forward the information and a copy of the lease to the State Negotiator for further determination and action. FORMCHECKBOX Forward the attached information and copy of lease to the State Negotiator for further determination of the validity of possible leasehold interest.Remarks:Date:Please Return to Submitting PartyArea Negotiator ................
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