To:	Acquisition Manager

From:	enter name, District R/W Supervisor

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

Parcel No.	From Sta.	To Sta.	Subdivisions	Sec.	T.	R.	County
enter text	enter text	enter text	enter text	enter text	enter text	enter text	enter text

Total Area of the Parcel:	enter text

General Location of the Parcel:	enter text

Zoning:	enter text	Does Parcel Conform to Zoning?	☐ Yes	☐ No

OWNER:	enter text	ADDRESS:	enter text

Phone:	enter text

Type of Deed	enter text	Filed choose a date	Book enter text	Page enter text

Choose an item	Date Filed	Choose a date.	Book	enter text	Page	enter text
Name of Choose an item	enter text
Address	enter text
Name of Trustee	enter text
Address	enter text

CONTRACT FOR SALE:	enter text
LEASE:	enter text

Date of Final Offer Letter: choose a date	Date of Response: choose a date

Owner's Counteroffer	$ enter text (Explain fully in remarks)

LAND COMPENSATION
enter text	$ enter amt

EASEMENTS
Permanent	enter text	$ enter amt
Temporary	enter text	$ enter amt

DAMAGES
Depreciation to Remainder	enter text	$enter amt
Cost to Cure	enter text	$enter amt
Major Improvements	enter text	$enter amt
Site Improvements	enter text	$enter amt
TOTAL DAMAGES	$enter amt
TOTAL COMPENSATION	$enter amt

FENCING
Station	enter text	Station	enter text	Choose an item	Choose an item
Note: If owner requested additional fencing, explain in remarks

SPECIAL CONSIDERATIONS
enter text

APPRAISALS/REVIEWS

Type of Appraisal:	enter text	Amount:	$enter amt
Appraiser:	enter text	Date:	Choose a date

REASONS FOR DIFFERENCE BETWEEN APPRAISAL & REVIEW:
enter text

ADMINISTRATIVE OFFER (if made)	Date: Choose a date	HOW MADE enter text

AMOUNT $ enter text	REASONS FOR OFFER	enter text

NEGOTIATOR	enter text
ALL DATES OF CONTACT	enter text

(List any MDT employee/agent, other than negotiator, who contacted owner, Contract Purchaser, lessee, etc.)
NAME & CAPACITY	DATES
enter text	enter text

WHO TO CONTACT (If other than Owner, explain relationship)
enter text	Work: enter text	Home: enter text	Hours to Call: enter text
enter text	Work: enter text	Home: enter text	Hours to Call: enter text
enter text	Work: enter text	Home: enter text	Hours to Call: enter text

R E M A R K S

(Provide detailed narrative with any information to help Attorneys prepare the parcel for Condemnation. Explain defects in title and information pertaining to estates. Use additional sheets if required. List all items pertaining to land value, damages and special considerations demanded by owner, C/P or Lessee, including additional approaches, culverts, or other design features. Explain any frustration of future plans complained of, or other project impacts on the property claimed by owner.)

enter text

Does owner have a lawyer concerning the taking? enter text
Who?	enter text

Has Grant of Possession been obtained for early construction and/or utility moves?	☐ Yes	☐ No

Will owners oppose a Grant of Possession?	☐ Yes	☐ No

Date Litigation Guarantee request sent to Plans Section:	Choose a date

ELECTRONIC SIGNATURE CONSENT

By my signature/typewritten name, I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications or misrepresentations.

Signature (Typed Name)	Date	Place of Signature (City, State)
Choose a date

Right-of-Way Agent

Consultant Signature (if applicable)	Date

** SEND COMPLETED FORM TO ACQUISITION MANAGER **