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Local Public Agency (LPA) Forms & Brochures

Agencies that acquire property and/or property rights/interests for federal-aid project will use the generic forms and brochures provided on this site. Terms of Use: The forms available for download are general in nature, and should only be used after first consulting with an attorney or other expert knowledgeable in the laws of the applicable jurisdiction and the specific intended use of those forms.

I need forms for - select the specific discipline form you are looking to obtain.

General  :  Local Agency Coordinator (for WSDOT use)
Appraisal  :  Acquisition  :  Certification  :  Property Management  :  Relocation

LPA Brochures – the following generic brochures are available to local agencies for distribution to property owners and tenants that will be impacted by their federal-aid transportation projects.

Another option is to disburse the FWHA brochures, which can be obtained online directly from the FHWA website.

LPA General Forms – forms used by local agencies that cover general program areas.

LPA-001: Right of Way Procedures (docx 32 kb)

LPA-003: Waiver of Appraisal Procedure (docx 26 kb)

LPA-004: Title Clearing for Right of Way Parcel Package (docx 46 kb)


LAC Forms – forms used by WSDOT’s Local Agency Coordinator (LAC) to perform the Right of Way Certification Review. Local agency staff or consultants can review the forms to understand file expectations prior to requesting a Certification Review.

LPA-011: Project Review Worksheet (docx 39 kb)

LPA-012: Parcel Review Worksheet (docx 38 kb)

LPA-013: Residential Relocation Review Worksheet (docx 38 kb)

LPA-014: Non-Residential Relocation Review Worksheet (docx 40 kb)

LPA-015: Personal Property Only (PPO) Relocation Review Worksheet (docx 37 kb)

LPA-016: Certification Review Oversight Report (docx 28 kb)

LPA-017: Certification Review Transmittal Letter (Cert 1 and 2) (docx 30 kb)

LPA-017a: Certification Review Compliance Letter (Cert 1 or 2 – No Cert at this time) (docx 28 kb)

LPA-018: Certification Review Transmittal Letter (Cert 3) (docx 34 kb)

LPA-019: Spot Check & Certification Review Sample Size Determination Worksheet (xlsx 19 kb)

LPA-020: Project QA/QC Review Form (docx 33 kb)

LPA-021: Parcel QA/QC Review Form (docx 35 kb)

LPA-022: Relocation Oversight Review Form (docx 33 kb)


LPA Appraisal Forms – forms used by local agencies that pertain to the appraisal function.

LPA-200: Appraisal Assignment Scope of Work (docx 36 kb)

LPA-203: Appraiser Assignment Form (docx 23 kb)

LPA-204: Report of Contact with Owner (docx 22 kb)

LPA-205: Certificate of Appraiser (docx 26 kb)

LPA-206: Summary of Appraisal Conclusions (docx 24 kb)

LPA-207: Subject Plot Plan and Photos (docx 22 kb)

LPA-208: Narrative Appraisal Report (docx 55 kb)

LPA-210: Market Data Sheet (docx 56 kb)

LPA-210b: Sale Sketch and Photographs (docx 22 kb)

LPA-211: Appraisal Assumptions and Limiting Conditions (docx 23 kb)

LPA-212: Acquisition Appraisal Salient Information (docx 23 kb)

LPA-213: Abbreviated Appraisal Report (docx 24 kb)

LPA-214b: Local Agency Certificate of Value (docx 32 kb)

LPA-215: Project Funding Estimate PFE Parcel Worksheet (docx 24 kb)

LPA-215b: True Cost Estimate Parcel Worksheet (docx 24 kb)

LPA-215c: Project Funding Estimate/True Cost Estimate Summary Worksheets (xls 22 kb)

LPA-216: Administrative Offer Summary (AOS) (docx 29 kb)

LPA-217: Residential Personalty/Realty Report (xls 29 kb)

LPA-218: Commercial/Industrial Personalty/Realty Report (xls 31 kb)

LPA-219: Certificate of Appraiser (docx 34 kb)

LPA-220: Mobile Home worksheet Personal Property (docx 24 kb)


LPA Acquisition Forms – forms used by local agencies that pertain to the acquisition of real property or property rights/interests.

LPA-300: Recording Cover Sheet (docx 42 kb)

LPA-301: Diary (docx 47 kb)

LPA-302: Warranty Deed (docx 51 kb)

LPA-303: Special Warranty Deed (docx 51 kb)

LPA-305: Warranty Deed (Access Rights Only) (docx 51 kb)

LPA-306: Quitclaim Deed (docx 51 kb)

LPA-307: Quitclaim Deed (Access Rights Only) (docx 52 kb)

LPA-308: Partial Release of Mortgage (docx 52 kb)

LPA-309: Partial Release Of Mortgage (Access Rights Only) (docx 52 kb)

LPA-310: Request For Partial Reconveyance (docx 48 kb)

LPA-311: Partial Reconveyance (docx 48 kb)

LPA-312: Partial Release Of Lease (docx 50 kb)

LPA-313: Release of Lease (docx 50 kb)

LPA-314: Subordination Agreement of Utility Interests (docx 28 kb)

LPA-315: Release of Damages (docx 32 kb)

LPA-316: Partial Release Of Judgment (docx 46 kb)

LPA-317: Possession and Use Agreement (docx 56 kb)

LPA-321: Real Property Voucher (Excel) (xlsx 60 kb)

LPA-323: Consent to Change of Grade (docx 50 kb)

LPA-324: Easement (docx 51 kb)

LPA-325: Temporary Easement (docx 51 kb)

LPA-326: Permit (docx 51 kb)

LPA-330: Bill of Sale (docx 43 kb)

LPA-333: Request to Accept Mortgage (deed of trust) Encumbrance (docx 30 kb)

LPA-333a: Letter to Owner-Agree to Pay Mortgage (deed of trust) Encumbrance (docx 30 kb)

LPA-335: Fixtures and Improvements Agreement (docx 27 kb)

LPA-350: Offer Letter (docx 58 kb)

LPA-351: Revised Offer Letter (docx 26 kb)

LPA-352: Landlord/Tenant Form (docx 28 kb)

LPA-355: Quitclaim Deed (Release Easement) (docx 28 kb)

LPA-356: Quitclaim Deed (Access Use for Easement) (docx 24 kb)

LPA-362: Agency Payment Letter (docx 18 kb)

LPA-365: Individual Notary (docx 25 kb)

LPA-366: Corporate Notary (docx 25 kb)

LPA-367: Attorney In Fact Notary (docx 25 kb)

LPA-368: Self and Attorney In Fact Notary (docx 25 kb)

LPA-369: Guardian, Executor, Administrator Notary (docx 25 kb)

LPA-370: Mayor City Commissioners Notary (docx 25 kb)

LPA-371: County Commissioners Notary (docx 25 kb)

LPA-372: School District Notary (docx 25 kb)

LPA-373: Signature by Mark Notary (docx 25 kb)

LPA-374: Partnership Notary (docx 25 kb)

LPA-375: Trustee Notary (docx 25 kb)

LPA-376: Limited Liability Company Notary (docx 25 kb)

LPA-377: Agency Notary (docx 25 kb)

LPA-382: Relocation Eligibility Report (docx 26 kb)

LPA-383: Donation and Appraisal Waiver (docx 22 kb)


LPA Certification Forms – forms used by local agencies to request a Right of Way Certificate so their federal-aid project can be authorized for construction.

LPA-384: Right of Way Certificate 1, No Relocation (docx 17 kb)

LPA-385: Right of Way Certificate 1, Residential Relocation (docx 17 kb)

LPA-386: Right of Way Certificate 1, Non-Residential Relocation (docx 18 kb)

LPA-387: Right of Way Certificate 1, Combination of Relocation Types (docx 17 kb)

LPA-388: Right of Way Certificate 2, No Relocation (docx 17 kb)

LPA-389: Certificate 2, Residential Relocation (docx 17 kb)

LPA-390: Right of Way Certificate 2, Non-Residential Relocation (docx 18 kb)

LPA-391: Right of Way Certificate 2, Residential and Non-Residential Relocation (docx 17 kb)

LPA-392: Right of Way Certificate 3, No Relocation (docx 22 kb)

LPA-393: Right of Way Certificate 3, Residential Relocation (docx 22 kb)

LPA-394: Right of Way Certificate 3, Non-Residential Relocation (docx 22 kb)

LPA-395: Right of Way Certificate 3, Residential and Non-Residential Relocation (docx 22 kb)

LPA-396: Right of Way Certificate 3, Design Build Phased – Under Construction

LPA-397: Certification Worksheet (xlsx 32 kb)

LPA-398: Certification Worksheet – Design Build (xlsx 33 kb)

LPA-399: WSDOT Local Agency Certification Concurrence Letter (docx 27 kb)

LPA-400: Preliminary Certification Statement for Design Build Projects (docx 22 kb)


LPA Property Management Forms – forms used by local agencies that pertain to the management of property purchased that is no longer needed for their federal-aid project.

LPA-407: Disposal Approval Request (docx 29 kb)


LPA Relocation Forms – forms used by local agencies that pertain to providing a variety of relocation assistance activities for residential, non-residential, and personal property only displacements.

LPA-501: General Notice of Relocation Rights (Non-Residential) (docx 29 kb)

LPA-502: General Notice of Relocation Rights (Landlord) (docx 21 kb)

LPA-503: General Notice of Relocation Rights (Personal Property) (docx 20 kb)

LPA-504: General Notice of Relocation Rights (Residential) (docx 20 kb)

LPA-505: Notice of Eligibility, Entitlements, and 90-Day Assurance (Non-Residential) (docx 38 kb)

LPA-506; Notice of Eligibility, Entitlements, and 90-Day Assurance (Non-Residential Fixed Payment) (docx 32 kb)

LPA-507: Notice of Eligibility, Entitlements, and 90-Day Assurance (Residential Owner) (docx 29 kb)

LPA-507a: Notice of Revised Price Differential (Residential Owner) (docx 29 kb)

LPA-507b: Notice of Eligibility – Non DSS (Residential Owner) (docx 29 kb)

LPA-507c: Notice of Eligibility w/Carve Out Language (Residential Owner) (docx 30 kb)

LPA-508: Notice of Eligibility, Entitlements, and 90-Day Assurance (Residential Tenant) (docx 30 kb)

LPA-508a: Notice of Eligibility – Non DSS (Residential Tenant) (docx 29 kb)

LPA-509: Notice of Eligibility, Entitlements, and 90-Day Assurance (Landlord) (docx 25 kb)

LPA-510: Notice of Eligibility, Entitlements, and 90-Day Assurance (Personal Property) (docx 28 kb)

LPA-511a: Notice of Relocation Eligibility, Entitlements, and 90-/Day Assurance (Mobile Homes – Own Mobile Home, Rent Site) (docx 34 kb)

LPA-511b: Notice of Relocation Eligibility, Entitlements, and 90-/Day Assurance (Mobile Homes – Own Mobile Home, Own Site) (docx 33 kb)

LPA-511c: Notice of Relocation Eligibility, Entitlements, and 90-/Day Assurance (Mobile Homes – Rent Mobile Home, Rent Site) (docx 31 kb)

LPA-512: Notice of Intent to Acquire (docx 16 kb)

LPA-513: Mortgage Interest Differential Payment (MIDP) (docx 19 kb)

LPA-514: Incidental Purchase Expense Work Sheet (docx 27 kb)

LPA-515: Documentation of Living Expenses (docx 21 kb)

LPA-516: Price Differential Entitlement Instructions (docx 20 kb)

LPA-516a: Down Payment Assistance Entitlement Instructions (docx 19 kb)

LPA-517: Vacate Inspection (docx 17 kb)

LPA-518: Agreement for Provisional Replacement Housing Payment (docx 18 kb)

LPA-519: Fixed Payment (In-Lieu) Work Sheet – Non-Residential (docx 19 kb)

LPA-520: Request for Moving Bid Cover Letter (docx 15 kb)

LPA-521: Request for Proposal and Moving Specification Format (docx 38 kb)

LPA-522: Replacement Site Search Log (docx 17 kb)

LPA-523: Application for Reestablishment Expenses – Non-Residential (docx 21 kb)

LPA-525: (DSS) Replacement Dwelling Inspection Report (docx 21 kb)

LPA-526: Loss of Tangibles/Substitute Personal Property Bid Form (docx 15 kb)

LPA-527: Loss of Tangibles Computation (docx 19 kb)

LPA-528: Substitute Personal Property Computation (docx 19 kb)

LPA-529: Residential Checklist (docx 22 kb)

LPA-530: Non-Residential Checklist (docx 28 kb)

LPA-531: Personal Property Checklist (docx 18 kb)

LPA-532: Residential Occupancy Survey (docx 34 kb)

LPA-533: Non-Residential Occupancy Survey (docx 30 kb)

LPA-533a: Non-Residential (Landlord) Occupancy Survey (docx 24 kb)

LPA-534: Personal Property Only Occupancy Survey (docx 28 kb)

LPA-535: Pre Move Inventory – Non-Residential (docx 25 kb)

LPA-536: Final Claim Letter – Non-Residential (docx 16 kb)

LPA-536a: Final Claim Letter – Residential (docx 16 kb)

LPA-537: Relocation Assistance Voucher (docx 31 kb)

LPA-538: Application for Fixed Payment – Non-Residential (docx 18 kb)

LPA-539: Residential Tenants Monthly Income Verification (docx 19 kb)

LPA-540: Move Expense Agreement – Residential (docx 25 kb)

LPA-540a: Move Expense Agreement – Non-Residential (docx 20 kb)

LPA-541: Housing Comparison Work Sheet (docx 25 kb)

LPA-542: Price Differential Report (docx 19 kb)

LPA-542a: Price Differential Report instructions (docx 25 kb)

LPA-543: Rent Supplement Report (docx 21 kb)

LPA-543a: Rent Supplement Report instructions (docx 21 kb)

LPA-544: Notice of Relocation Non-eligibility (docx 17 kb)

LPA-545: Non-Residential Obsolete Printed Items (docx 16 kb)

LPA-546: Mobile Home Move Cost – Personal Property (docx 24 kb)

LPA-547: Lawfully Present in the United States Certification (docx 23 kb)

LPA-548: Transfer of Ownership – Non-Residential (docx 23 kb)

LPA-549: Claim Determination Letter (docx 22 kb)

LPA-550: Notification of Professional Home Inspection (docx 26 kb)