Landowner name

Address.

City, State, Zip

Subject:	Project ID:	enter text
Project No.:	enter text
Designation:	enter text
Parcel No.:	enter text

This letter is to advise that, except as noted below, you are entitled to reimbursement for real estate taxes actually paid on the portion of your property being acquired by the Department of Transportation. The State shall reimburse you for the remaining tax period after the State acquired title to or possession of your property, whichever is the earlier date.

EXCEPTION: No reimbursement will be made if the State acquires only a portion of your property and the reimbursable amount is five dollars ($5.00) or less, as computed by the State when your request for reimbursement is received.

Reimbursement will be made when you have fulfilled the following requirements:

1.	All current real estate taxes must be paid in full.

2.	In the event only a portion of your property is being purchased, it will be necessary for you to have the Local County Office of the Department of Revenue, Property Assessment Division complete Section B on the attached page. This requirement is not necessary when your entire property is purchased.

3.	All Sections must be completed before submitting to the State of Montana, Department of Transportation, Engineering Fiscal Operations, P.O. Box 201001, Helena, Montana 59620-1001, with documents as required by Section C.

This is your official notice from the State of Montana concerning this reimbursement provision.

Thank you.

STATE OF MONTANA

DEPARTMENT OF TRANSPORTATION

enter name, Right-of-Way Agent	Date

REQUEST FOR REIMBURSEMENT FOR TAXES PAID

SECTION A -	To be completed by District Right-of-Way Agent, State of Montana, Department of Transportation.

1.	Identification:

Project ID:	enter text	Project No.:	enter text
Designation:	enter text	County:	enter text
Parcel No.:	enter text
Property Owner:	enter text	☐ Partial Acquisition
Contract Purchaser:	enter text	☐ Total Acquisition of Entire Ownership

2.	Land acquired is located in:

a.	Urban or Suburban Subdivision as follows:

Lot(s)	Block(s)	Subdivision	City, or Sec/Township/Range
enter text	enter text	enter text	enter text
enter text	enter text	enter text	enter text

b.	Rural Location as follows:

Subdivision(s)	Section	Township	Range
enter text	enter text	enter text	enter text
enter text	enter text	enter text	enter text

3.	Property acquired:

a.	Land

Area	General Land Classification (grazing, cultivated, etc.
enter text	enter text
enter text	enter text

b.	Improvements	Location

enter text	enter text
enter text	enter text

SECTION B -	To be completed by Local County Office of the Department of Revenue, Property Assessment Division. (Not applicable when the State of Montana, Department of Transportation acquires total ownership.)

Based on the information shown in Section A, I have determined that the total general real estate tax for ______ (year) apportionate to the land and improvements acquired by the State of Montana, Department of Transportation is $________________________.

Please enclose supporting documentation to support property tax reimbursement, noted above.

Signature: __________________________________ Date: __________________________________

Phone Number: _____________________________________

SECTION C - REQUEST FOR TAX REIMBURSEMENT completed by Landowner. (Mark one of the following)

( )	I have paid taxes and am enclosing the required tax receipt, which shall be returned to me after reimbursement.

( )	The State acquired all of my property and I desire to have the State pay the tax shown on the enclosed statement in my name by assignment to the County Treasurer from the amount withheld from the compensation paid for my property. I understand that I shall be reimbursed for taxes in an amount representing the portion of the year that the State has had possession of my property.

I fully understand that the State of Montana will compute the pro rata portion of taxes to be reimbursed based on apportionment State tax accounting procedures.

Dated this __________ day of _______________________,

_______________________________________________

Signed

_______________________________________________

Address

_______________________________________________

City and State Zip Code