Relocatee:	enter text	Project No.:	enter text
Address:	enter text	Designation:	enter text
Telephone No.:	enter text	Parcel No.:	enter text

SUBJECT PROPERTY:	enter address

Type of Unit:	☐ Single family	☐ Duplex	☐ Other: enter text
Occupants: enter text	Family Income: enter text	Bedrooms: enter #
Utilities:	Choose item	Bathrooms:	enter #	Total SF: enter text
Garage? Choose item	Storage Shed? Choose item

Comparable #1:	enter address

Bedrooms:	enter text	Bathrooms:	enter text	Total SF: enter text
Garage? Choose item	Storage Shed? Choose item
Comments:	enter text

Inspected for DSS: ☐ Yes : ☐ No

Comparable #2:	enter address

Bedrooms:	enter text	Bathrooms:	enter text	Total SF: enter text
Garage? Choose item	Storage Shed? Choose item
Comments:	enter text

Inspected for DSS: ☐ Yes : ☐ No

Comparable #3:	enter address

Bedrooms:	enter text	Bathrooms:	enter text	Total SF: enter text
Garage? Choose item	Storage Shed? Choose item
Comments:	enter text

Inspected for DSS: ☐ Yes : ☐ No

Feature	Subject	Comp 1	Comp 2	Comp 3
Bedrooms	enter	enter	enter	enter
Bathrooms	enter	enter	enter	enter
Total SF	enter	enter	enter	enter
Garage	enter	enter	enter	enter
Storage shed	enter	enter	enter	enter

All comparables are considered as reasonable replacements to the subject. Where feasible, comparable housing shall be inspected prior to being made available to ensure that it meets applicable decent safe and sanitary standards. A replacement housing payment may not be made unless the replacement dwelling is subsequently inspected and determined to be decent, safe and sanitary.

A DSS Inspection only verifies that the property contains specific requirements. The DSS inspection does not contain information as to the general condition of a property. A DSS inspection is not intended to replace a Home Inspection.

Comparable Sale determined to be the most comparable:
enter text

Choose a building block.

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)

MDT Relocation Agent