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

State of _________________________

County of

enter text, being first duly sworn, says that he is the enter text of enter text and that project enter text has been constructed under his supervision a distance of enter text miles, across a portion of the enter text, Montana; that this construction began on choose a date, and completed on choose a date; that the right-of-way does not materially deviate from the approved plans, notes and maps filed choose a date

Engineer

Dated this	day of	,	20

This instrument was acknowledged before me on
(date)

By

(Seal)
Notary Signature Line
Notary Printed Name
Notary Public for State of
Residing at:
My Commission Expires:	/	/	20

CERTIFICATE

I, enter text, do hereby certify that I am the enter text for enter text. That enter text, who subscribed the foregoing affidavit, is also employed by the Department of Transportation; that in its construction the right-of-way does not deviate from the approved plans, notes and maps filed Choose a date.; and the Department of Transportation has in all things complied with the requirements of the Act of February 5, 1948, and applicable regulations pursuant to which the Department of Transportation has been granted the right-of-way.

Signature	Title