RELOCATION PAYMENTS SUMMARY / RESIDENTIAL Wisconsin Department of Transportation

RE1679R 03/2012 Ch. 32 Wis. Stats.

Original Revised

Name / Address
Approved Offering Price / Carve Out Value / $
This summary is to confirm relocation payments you may be eligible for as a result of the acquisition of your property.
Replacement Housing Payment for Owner Occupants
Supplemental housing payment for an owner occupant for not less than 180 days who purchases.* / $
Supplemental housing payment – down payment for an owner occupant for less than 180 days, but not less than 90 days who purchases.* / $
* Above amounts may be adjusted whenever offering price is revised to properly show correct differential amount required toward purchase of a replacement property.
Replacement Housing Payment for Tenant Occupants
Down payment for a tenant occupant for not less than 90 days who purchases. / $
Supplemental rent payment for an owner occupant for a period of not less than 90 days who rents (to be paid in four annual installments, if requested). / $
Supplemental rent payment for a tenant occupant for not less than 90 days who rents (to be paid in two installments). / $
Expenses Incidental to Purchase of Replacement Housing (amounts to be determined as they occur)
1.  Increased interest costs.
2.  Legal, closing and related costs, including: title search, preparing conveyance contracts, notary fees, surveys, preparing drawings or plats, and charges paid incident for recording, credit report, application fees, incidental fees, etc.
Moving Expenses – Residential
Actual and reasonable cost to move personal property from residences and mobile homes based on receipted bills from qualified mover. / $
OR
Fixed schedule – residential, including sleeping rooms and mobile home occupants Schedule for: Room(s) is: / $
Incidental Expenses – Transfer of Property to State, if applicable (s. 32.195 Wis. Stats.)
Net rental loss / Recording fees and similar items / Prepayment penalty cost
Realignment of personal property / Plan expenses rendered unusable / Fencing cost
Prorated share of taxes
RECEIVED from agent on for WisDOT, a "relocation package," containing a relocation assistance brochure and forms. Agent has also explained services and payments that WisDOT offers to me as a relocatee.
______
Signature Date
Project ID / County / Parcel No.