Scope of Work: The Waiver Valuation is to be used to report the Market Value Estimate of uncomplicated low value acquisitions, with or without improvements and/or with nominal depreciation to the remainder, that can be measured by a cost to cure which results in no loss in market value to the remainder “as cured.” Market information on similar property and cost estimates are used to develop the Market Value Estimate. See Section 4-3.3 of the R/W Operations Manual for instructions on completing a Waiver Valuation and Chapter 3 of the R/W Operations Manual for the definition of Market Value and USPAP Jurisdictional Exceptions.

(1)	Current Project Information
PROJECT NO.:	[Project No.]	PROJECT ID:	enter text
DESIGNATION:	[Designation]	PARCEL NO.:	[Parcel No.]

IF property being valued is MDT property, list project information from when MDT acquired the property:
PROJECT NO.	enter text	PROJECT ID:	enter text
DESIGNATION:	enter text	PARCEL NO.:	enter text

(2)	RECORD OWNER:	enter text
ADDRESS:	enter text
CITY, STATE, ZIP	enter text
PHONE NO.	enter text

CONTRACT PURCHASER:	enter text
ADDRESS:	enter text
CITY, STATE, ZIP	enter text
PHONE NO.	enter text

LESSEE OF ACQUISITION:	enter text
ADDRESS:	enter text
CITY, STATE, ZIP	enter text
PHONE NO.	enter text

Date Taken:	choose date	Taken By:	enter text
Taken From:	enter text	Facing:	enter text
Remarks:	enter text

(3)	LARGER PARCEL SIZE & LAND VALUE CLASSIFICATION:
enter text

(4)	LAND VALUE ANALYSIS (State data source and/or reference sales used in support of the valuation:
enter text

(5)	VALUE OF IMPROVEMENTS (including on-premise signs):
enter text
Personal property not considered realty in acquisition, easement, or construction permit	☐ Yes ☐ No
If Yes, please describe: enter text

(6)	DEPRECIATION IN VALUE TO THE REMAINDER (State data source and/or attach contractor estimate):
enter text

(7)	VALUATION:
Compensation for land & improvements:
Land:
Fee Simple
enter text	enter $ amt
Easements
enter text	enter $ amt
Improvements (inclusive of site improvements);
enter text	enter $ amt
Fixtures & personal property (considered realty):
enter text	enter $ amt
Subtotal of Land & Improvements	enter $ amt
Other compensation:
Construction permits:
enter text	enter $ amt
Cost to cure:
enter text	enter $ amt
Admin & oversight fee 5% of total contractor estimate(s) * 5% of total contractor estimates - $50 min., $2,500 max	enter $ amt
Subtotal of Other Compensation	enter $ amt
Total Compensation:	enter $ amt
Compensation (Minimum Payment or Rounded):	enter $ amt
TOTAL COMPENSATION	enter $ amt

(8)	LESSEES INTEREST: enter text
LESSORS INTEREST: enter text

(9)	I CERTIFY THAT:
In the preparation of this valuation assignment, I have personally inspected this property and have no present of contemplated future interest herein; that the compensation to me for this valuation service is not contingent upon my value conclusions herein set forth; and that all statements herein are true to the best of my knowledge and belief. That the landowner has approved the use of a Waiver Valuation, in writing, if the valuation is between $10,001 to $25,000.

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 of Report	Place of Signature (City, State)
Choose a date

Right-of-Way Agent

Date of Value:	Choose a date

Consultant Signature (if applicable)	Date

APPROVED FOR AND ON BEHALF OF DEPARTMENT

(10)	The data, analysis, adjustments, methods, techniques, opinions, and conclusions appear to be appropriate, complete, adequate and relevant, and are approved.
I certify that:
the estimated compensation does not contain items which are not eligible for Federal reimbursement the Waiver Valuation and Approval have been made in conformity with Federal Law, State Law, and Chapter 3 (Appraisal) of the MDT R/W Operations Manual I have no direct or indirect present or contemplated future personal interest in the subject property or in any benefit from the acquisition of such property. neither my employment nor compensation is contingent on an action, event or value resulting from the analyses, opinions, or conclusions in, or the use of, this report. This is a Restricted Use Report for Right of Way acquisition only
TOTAL COMPENSATION, ROUNDED	enter $ amt

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

Choose title

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

Review Appraiser (if total compensation is between $10,001-$25,000 and parcel is negotiated by Field R/W Supervisor)

(11)	EXISTING FENCING IN ACQUISITION AREA:
A.	Station-to-Station	enter text

(12)	HISTORY:
Owner contacted, if applicable, but not required	Date: Choose date	Manner of contact: enter text
Summary of issues discussed:	enter text

PERSONS OR FIRMS CONTACTED, IF APPLICABLE:
Date	Name	Phone	Address
enter text	enter text	enter text	enter text
enter text	enter text	enter text	enter text
enter text	enter text	enter text	enter text

Attachments: Waiver Valuation Letter (Form 414) if the valuation is between $10,001 - $25,000

NOTE: The limitation of this form ($25,000) cannot be waived