R/W Project ID:	enter text
R/W Project No.:	enter text
Designation:	enter text
Parcel No.:	enter text
Landowner Name:	enter text

Settlement Amount	$enter text
Approved Appraisal Amount	$enter text
Administrative Settlement Amount	$enter text

☐	The Administrative Settlement is justified on the following basis:
(Replace this portion with your justification. Your justification must include at a minimum what the landowner wants & why; a statement that the landowner will not sign without this settlement, and a statement about the settlement being less costly than the cost of condemnation (this requires input from Legal).) The amount of justification should be based on the settlement amount. Refer to Section 4-3.8 of the R/W Operations manual for additional direction for writing justifications

☐	All or a portion of the variance in the amount of $enter text cannot be justified in accordance with Federal Aid Regulations, and is, therefore, not eligible for Federal Participation for the following reasons:
enter text

RECOMMENDED FOR APPROVAL

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

Signature (Typed Name)	Date	Place of Signature (City, State)
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Right-of-Way Supervisor

Signature (Typed Name)	Date	Place of Signature (City, State)
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District Administrator

Signature (Typed Name)	Date	Place of Signature (City, State)
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Legal

APPROVED FOR AND ON BEHALF OF DEPARTMENT

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)
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Right-of-Way Supervisor *

Signature (Typed Name)	Date	Place of Signature (City, State)
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District Administrator

Signature (Typed Name)	Date	Place of Signature (City, State)
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Acquisition Manager or Bureau Chief

Signature (Typed Name)	Date	Place of Signature (City, State)
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Preconstruction Engineer or Chief Engineer

* If amount is within delegated authority as identified in the Right-of-Way Manual.