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enter text	PE Project ID: enter text
Designation
R/W Project ID: [enter text]
enter text
Montana County	Uniform Project No.: enter text

Parcel	From Station	To Station	QtrQtr, Tract, COS #, Etc.	Section	Township	Range
[enter text]

List Names & Addresses of the Grantors

(Contract Purchaser, Contract Seller, Lessee, etc.)

In consideration of the payments herein set forth and the specific agreements to be performed by the parties hereto and written in this agreement, the parties bind themselves to the terms and conditions stated herein. No verbal representations or agreements shall be binding upon either party. This agreement is effective upon execution by the Acquisition Manager or a designated representative, and possession of the property is granted to the Department when it sends the payment(s) agreed to below. Grantors certify that any encumbrances on the property are shown on this agreement. If Grantors sell their remaining property prior to the highway project being constructed, Grantors agree to provide the Purchaser(s) with a copy of this entire Right-of-Way Agreement and agree to make the sale of their remaining property subject to all the terms and conditions contained in this Right-of-Way Agreement. Grantors contract that they will, on Department’s request, execute deeds and/or easements required by Department for all real property agreed to be conveyed by this agreement.

COMPENSATION FOR LAND AND IMPROVEMENTS (list acreage and improvements to be acquired.)

OTHER COMPENSATION

TOTAL COMPENSATION (includes all damages to the remainder): enter text

IT IS UNDERSTOOD AND AGREED THE STATE SHALL MAKE PAYMENTS AS FOLLOWS:

THE PARTIES HERETO HAVE EXECUTED THIS AGREEMENT ON THE DATES SHOWN: Grantors’ Statement: We understand that we are required by law to provide our correct taxpayer identification number(s) to the Montana Department of Transportation and that failing to comply may subject us to civil and criminal penalties. We agree to provide our correct taxpayer identification number(s) by submitting a completed and signed W-9 or W-8 form. We further agree to provide MDT with a completed and signed W-9 or W-8 from all persons and/or entities receiving payments by assignment from us in this agreement. We further agree and authorize MDT to process the payments outlined in this agreement by withholding a percentage of the payments, if required by the IRS, if we fail to submit the W-9 or W-8 forms within 30 days of signing this agreement.
Signature: enter name	Date
Signature: enter name	Date
Recommended for Approval:	Approved for and on Behalf of Department
R/W Agent: Enter name	Date	NSOP Items Approved, if Applicable	Date
R/W Supervisor: Enter name	Date
Consultant Project of R/W Manager, if applicable Enter name	Date
Acquisition Manager: Enter name	Date