Relocation Assistance Program
Generic Form Revisions

WSDOT made changes to our generic relocation assistance forms due to the February 2005 changes made to the federal regulations (49CFR Part 24 Section 24) that govern the Uniform Relocation Assistance and Real Properties Acquisition Act of 1970, as amended. These WORD forms are generic in nature and should be used by local public agencies instead of using the WSDOT forms. Please contact Leslie Beaird, LPA & Consultant Relocation Reviewer at 360.705.7316 if you have any questions regarding the forms.

These forms are available in two file formats:
Microsoft Word (.doc)
Adobe Acrobat (.pdf)

Select the doc link for the Word version of the form OR
select the pdf link for the Adobe Acrobat version of the form.

Download Adobe Reader to view the .pdf versions of these files.

Contents

Local Public Agency Relocation Forms List
(doc 32 kb) (pdf 14 kb)

LPA-220 Mobile Home Worksheet - Personal Property
(doc 35 kb)(pdf 16 kb)

LPA-501 General Notice - Non-Residential
(doc 35 kb)(pdf 58 kb)

LPA-502 General Notice - Landlord
(doc 58 kb)(pdf 29 kb)

LPA-503 General Notice - Personal Property 
(doc 32 kb)(pdf 41 kb)

LPA-504 General Notice - Residential 
(doc 32 kb)(pdf 43 kb)

LPA-505 Notice of Eligibility - Non-Residential
(doc 45 kb)(pdf 42 kb)

LPA-506 Notice of Eligibility - Non-Residential (Fixed Payment)
(doc 34 kb)(pdf 37 kb)

LPA-507 Notice of Eligibility - Residential Owner
(doc 41 kb)(pdf 47 kb)

LPA-507a Notice of Revised Price Differential - Residential Owner
(doc 32 kb)(pdf 32 kb)

LPA-507b Notice of Eligibility - Non DSS Residential Owner
(doc 65 kb)(pdf 32 kb)

LPA-507c Notice of Eligibility - Residential Owner with Carve Out Language
(doc 66 kb)(pdf 36 kb)

LPA-508 Notice of Eligibility - Residential Tenant
(doc 43 kb)(pdf 47 kb)

LPA-508a Notice of Eligibility - Non DSS Residential Tenant
(doc 66 kb)(pdf 25 kb)

LPA-509 Notice of Eligibility - Landlord 
(doc 41 kb)(pdf 49 kb)

LPA-510 Notice of Eligibility - Personal Property
(doc 32 kb)(pdf 45 kb)

LPA-511a Notice of Relocation Eligibility & 90-Day Assurance Combo Letter (Mobile Homes - Rent Site, Own Mobile Home)
(doc 67 kb) (pdf 38 kb)

LPA-511b Notice of Relocation Eligibility & 90-Day Assurance Combo Letter (Mobile Homes - Own Site, Own Mobile Home)
(doc 64 kb) (pdf 40 kb)

LPA-511c Notice of Relocation Eligibility & 90-Day Assurance Combo Letter (Mobile Homes - Rent Site, Rent Mobile Home)
(doc 57 kb) (pdf 26 kb)

LPA-512 Notice of Intent to Acquire
(doc 46 kb) (pdf 17 kb)

LPA-513 Mortgage Interest Differential Payment (MIDP) Computation
(doc 55 kb)(pdf 15 kb)

LPA-514 Incidental Purchase Expense Worksheet
(doc 63 kb)(pdf 79 kb)

LPA-515 Documentation of Living Expenses
(doc 43 kb)(pdf 49 kb)

LPA-516 Price Differential Entitlement Instructions
(doc 45 kb)(pdf 123 kb)

LPA-516a Down Payment Assistance Entitlement Instructions
(doc 35 kb)(pdf 27 kb)

LPA-517 Vacate Inspection
(doc 28 kb)(pdf 21 kb)

LPA-518 Agreement for Provisional Replacement Housing Payment
(doc 29 kb)(pdf 21 kb)

LPA-519 Fixed Payment (In-Lieu) Worksheet Non-Residential
(doc 33 kb)(pdf 25 kb)

LPA-520 Request for Moving Bid cover letter
(doc 27 kb)(pdf 17 kb)

LPA-521 Move Bid Request and Specification
(doc 46 kb)(pdf 65 kb)

LPA-522 Replacement Site Search Log
(doc 45 kb)(pdf 65 kb)

LPA-523 Application for Reestablishment Expenses - Non-Residential
(doc 34 kb)(pdf 24 kb)

LPA-524 Eligibility Report
(doc 31 kb)(pdf 26 kb)

LPA-525 (DSS) Replacement Dwelling Inspection Report
(doc 59 kb)(pdf 18 kb)

LPA-526 Loss of Tangibles/Substitute Personal Property Bid Form
(doc 29 kb)(pdf 23 kb)

LPA-527 Loss of Tangibles Computation
(doc 38 kb)(pdf 33 kb)

LPA-528 Substitute Personal Property Computation
(doc 36 kb)(pdf 31 kb)

LPA-529 Residential Checklist
(doc 62 kb)(pdf 15 kb)

LPA-530 Non-Residential Checklist
(doc 66 kb)(pdf 15 kb)

LPA-531 Personal Property Checklist
(doc 44 kb)(pdf 12 kb)

LPA-532 Residential Occupancy Survey
(doc 91 kb)(pdf 29 kb)

LPA-533 Non-Residential Occupancy Survey
(doc 66 kb)(pdf 87 kb)

LPA-533a Landlord Occupancy Survey
(doc 77kb) (pdf 96kb)

LPA-534 Personal Property Only Occupancy Survey
(doc 42 kb)(pdf 14 kb)

LPA-535 Pre Move Inventory – Non-Residential
(doc 72 kb)(pdf 110 kb)

LPA-536 Final Claim Letter - Non-Residential
(doc 27 kb)(pdf 16 kb)

LPA-536a Final Claim Letter - Residential
(doc 27 kb)(pdf 16 kb)

LPA-537 Relocation Assistance Voucher
(doc 82 kb)(pdf 24 kb)

LPA-538 Application for Fixed Payment
(doc 37 kb)(pdf 16 kb)

LPA-539 Monthly Income Verification
(doc 47 kb)(pdf 57 kb)

LPA-540 Move Expense Agreement – Residential
(doc 33 kb)(pdf 27 kb)

LPA-540a Move Expense Agreement – Non-Residential
(doc 41 kb)(pdf 15 kb)

LPA-541 Housing Comparison Worksheet
(doc 92 kb)(pdf 17 kb)

LPA-542 Price Differential Report
(doc 53 kb)(pdf 15 kb)

LPA-543 Rent Supplement Report
(doc 66 kb)(pdf 16 kb)

LPA-544 Notice of Relocation Non-Eligibility
(doc 27 kb)(pdf 18 kb)

LPA-545 Non-Residential Obsolete Printed Items
(doc 44 kb)(pdf 14 kb)

LPA-546 Mobile Home Move Cost - Personal Property
(doc 39 kb) (pdf 29 kb)


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