1.	Project ID:	enter text	Project No.:	enter text

Designation:	enter text
Parcel #:	enter text

2.	Description of Right-of-Way (Acreage, Lot & Block, COS, Section, Township, Range, etc.):
enter text

3.	Property Owner(s):	enter text

4.	Waiver by Property Owner(s):

The undersigned, having first been informed concerning the right of the property owner to receive an appraisal of and payment for land acquired for highway right-of-way, do hereby waive said rights and voluntarily agree to donate the right-of-way needed for the above-named project.

Dated this ________ day of ______________________________, _____________

Property Owner(s):

Signature: enter text

Use the following if property owner is a Corporation, LLC, Trust, or Partnership, etc.

enter text	enter text
Signature	(title of Capacity)	Name of Corporation, LLC, Trust, etc.

Witness:

Signature	Printed Name

Distribution:

Original to:	Montana Department of Transportation

Copy to:	Property Owner