Relocation Payments Summary-Residential (DT1679)



RELOCATION PAYMENTS SUMMARY / RESIDENTIALWisconsin Department of TransportationRE1679R 03/2012 Ch. 32 Wis. Stats. FORMCHECKBOX Original FORMCHECKBOX RevisedName FORMTEXT ?????Address FORMTEXT ????? FORMCHECKBOX Approved Offering Price FORMCHECKBOX Carve Out Value$ FORMTEXT ?????This summary is to confirm relocation payments you may be eligible for as a result of the acquisition of your property.Replacement Housing Payment for Owner Occupants FORMCHECKBOX Supplemental housing payment for an owner occupant for not less than 180 days who purchases.*$ FORMTEXT ????? FORMCHECKBOX Supplemental housing payment – down payment for an owner occupant for less than 180 days, but not less than 90 days who purchases.*$ FORMTEXT ?????* Above amounts may be adjusted whenever offering price is revised to properly show correct differential amount required toward purchase of a replacement property.Replacement Housing Payment for Tenant Occupants FORMCHECKBOX Down payment for a tenant occupant for not less than 90 days who purchases.$ FORMTEXT ????? FORMCHECKBOX Supplemental rent payment for an owner occupant for a period of not less than 90 days who rents (to be paid in four annual installments, if requested).$ FORMTEXT ????? FORMCHECKBOX Supplemental rent payment for a tenant occupant for not less than 90 days who rents (to be paid in two installments).$ FORMTEXT ?????Expenses Incidental to Purchase of Replacement Housing (amounts to be determined as they occur)Increased interest costs.Legal, closing and related costs, including: title search, preparing conveyance contracts, notary fees, surveys, preparing drawings or plats, and charges paid incident for recording, credit report, application fees, incidental fees, etc.Moving Expenses – Residential FORMCHECKBOX Actual and reasonable cost to move personal property from residences and mobile homes based on receipted bills from qualified mover.$ FORMTEXT ?????OR FORMCHECKBOX Fixed schedule – residential, including sleeping rooms and mobile home occupants Schedule for: FORMTEXT ?????Room(s) is: FORMTEXT ?????$ FORMTEXT ?????Incidental Expenses – Transfer of Property to State, if applicable (s. 32.195 Wis. Stats.) FORMCHECKBOX Net rental loss FORMCHECKBOX Recording fees and similar items FORMCHECKBOX Prepayment penalty cost FORMCHECKBOX Realignment of personal property FORMCHECKBOX Plan expenses rendered unusable FORMCHECKBOX Fencing cost FORMCHECKBOX Prorated share of taxesRECEIVED from FORMTEXT ????? agent on FORMTEXT ????? for WisDOT, a "relocation package," containing a relocation assistance brochure and forms. Agent has also explained services and payments that WisDOT offers to me as a relocatee._____________________________________________________________SignatureDateProject ID FORMTEXT ?????County FORMTEXT ?????Parcel No. FORMTEXT ????? ................
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