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LPA Forms & Brochures

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.

Local Agency Forms and Brochures List (docx, 24kb) - October 2014

I need forms for:

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

LPA Brochures
There has been some confusion in the past with local agencies and consultants handing out Washington State Department of Transportation (WSDOT) relocation assistance brochures and displaced persons contacting WSDOT for information or to file their appeal.

So, WSDOT is now asking local agencies to prepare their own relocation brochures and not use WSDOT's. Our brochures should only be used for our highway improvement projects, because they list our regional offices, along with appeal information, etc. It is up to the acquiring agency to provide appropriate information to displacees.

Until a local agency can prepare brochure(s) of their own, they can use the generic brochures available on our Web site.

Transportation Property Needs and You - LPA Generic (pdf, 44kb)
Business/Farm/NPO Relocation Assistance Program - LPA Generic (docx, 32kb)
Personal Property Only Relocation Assistance Program - LPA Generic (docx, 20kb)
Residential Relocation Assistance Program - LPA Generic (docx, 24kb)

Another option is to disburse the FWHA brochures, which can be obtained online.

FHWA Relocation Brochure:

FHWA Relocation Brochure (Spanish Language Version):

FHWA Acquisition Brochure

FHWA Acquisition Brochure (Spanish Language Version):

LPA General Forms

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

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

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


LAC Forms(for WSDOT use)

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

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

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

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

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

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

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

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

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

LPA-019: Sample Size Determination Form (xlsx 19kb)

LPA-020: Project Oversight Review Form (docx 33kb)

LPA-021: Parcel Oversight Review Form (docx 35kb)

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


LPA Appraisal Forms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LPA-220: Additional Items Associated w/Move (docx 24kb)


LPA Acquisition Forms

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

LPA-301: Diary (docx 47kb)

LPA-302: Warranty Deed (docx 51kb)

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

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

LPA-306: Quitclaim Deed (docx 51kb)

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

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

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

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

LPA-311: Partial Reconveyance (docx 48kb)

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

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

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

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

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

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

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

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

LPA-324: Easement (docx 51kb)

LPA-325: Temporary Easement (docx 51kb)

LPA-326: Permit (docx 51kb)

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

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

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

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

LPA-350: Offer Letter (docx 58kb)

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

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

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

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

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

LPA-365: Individual Notary (docx 25kb)

LPA-366: Corporate Notary (docx 25kb)

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

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

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

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

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

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

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

LPA-374: Partnership Notary (docx 25kb)

LPA-375: Trustee Notary (docx 25kb)

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

LPA-377: Agency Notary (docx 25kb)

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

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


LPA Certification Forms

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

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

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

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

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

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

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

LPA-391: Certificate 2, Combination of Relocation Types (docx 17kb)

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

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

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

LPA-395: Certificate 3, Combination of Relocation Types (docx 22kb)

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

LPA-397: Certification Worksheet (xlsx 32kb)

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

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

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


LPA Property Management Forms

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


LPA Relocation Forms

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LPA-517: Vacate Inspection (docx 17kb)

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

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

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

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

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

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

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

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

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

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

LPA-529: Residential Checklist (docx 22kb)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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