Project #:	enter text	Project ID:	enter text
Designation:	enter text	Parcel #	enter text
District:	Choose a District

YES	NO
Is this the last relocation payment for this parcel on the project?	☐	☐

Relocation Agent
Yes	N/A
☐	☐	Establish the Relocation records in ROWA (name, status, property type, displaced , occupancy type, assigned user, and estimated amount).
☐	☐	360 - Parcel Information
☐	☐	381 - General Relocation Notice Choose a date
☐	☐	352 - 90-Day Notice to Vacate Letter Choose a date
☐	☐	365 - 30-Day Notice to Vacate Letter Choose a date
☐	☐	370 or 371 - Eligibility Letter – Residential Choose a date
☐	☐	359 - Comparable Replacement Housing
☐	☐	358 - Replacement Housing or Rental Listings
☐	☐	353 - Moving Expenses for Individual or family Choose a date
☐	☐	388 - Supplemental Housing Payment Owner-Occupant 90 days or more Choose a date
☐	☐	384 - Supplemental Housing Payment Tenant-Occupant 90 days or more Choose a date
☐	☐	355 - Decent, Safe and Sanitary Requirements
☐	☐	383 – Business – Farm/Ranch – Non-Profit Eligibility Letter (Choose a date)
☐	☐	366 - Business, Farm or Ranch, Non-Profit Moving Expense (Choose a date)
☐	☐	364 - Business, Farm or Ranch, Non-Profit Fixed Payment In-Lieu of Moving Expense
☐	☐	Form 350 - Application for Relocation Assistance Payment (Choose date) enter $ amt
☐	☐	Form 363 - Relocation Payment Summary (Choose date) enter $ amt
☐	☐	Form 397 or 208 - Signed History
☐	☐	Other Documentation: enter text

“I certify that I have completed all the necessary Right of Way documents associated with the subject relocation parcel as required for payment. These documents have been saved electronically in the Z-Finalized_Project_Docs folder>PAR_XXX>Relocation folder and are available for Acquisition Manager or District Right of Way Supervisor review and 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

Acquisition Manager
Yes	N/A
☐	☐	Verify all ROWA entries are established in the Relocation Tab and status is Closed.
☐	☐	Verify all finalized documents are saved to share drive - Z-Finalized_Project_Docs folder>PAR_XXX>Relocation folder
☐	☐	Approve documents for payment
☐	☐	Comments?

I certify that I have reviewed all the applicable Right of Way documents related to the subject parcel for completeness, accuracy, and compliance with MDT policies, /state and federal laws, and the documents contain all necessary signatures to support a landowner payment and recording.

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

HQ Compliance Compliance-Reference-Guide
Yes	Pending	N/A
☐	☐	☐	Review District ROWA Entries, are Completed, Verified, and Includes ROW Total Costs.
Date	Amount	Claim #
Choose a date	enter $ amt	enter text
Choose a date	enter $ amt	enter text

I verify that I have reviewed all the Right of Way documents referenced above and confirm that they are all available and saved electronically in the Z-Finalized_Project_Docs folder>PAR_XXX>Parcel Compliance folder. I have performed a cursory review to ensure signatures, dates, names, and amounts are accurate and present and that all documents required for payment have been submitted. I have documented the payment information.

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

Records Management Technician #1 Record-Mgmt.-Reference-Guide
Yes	N/A
☐	☐	Merge Relocation documents with the with the PAR_XXX.pdf documents in Project1-Index Section 5
☐	☐	Merge electronic AP Payment docs to the GEN_FILE.pdf in Project1.

I verify the Deed is recorded and has been returned to MDT from the County. I have prepared the Parcel and/or Project master PDF file.

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