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Local Public Agency Forms and Brochures

Local Public Agency Brochure Distribution

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.

Another option is to disburse the FWHA brochure, which can be obtained online. The address is:

Acquisition Brochure - Transportation Property Needs and You
Generic version (pdf, 44kb)

Relocation Brochures
Generic brochures

Local Public Agency Forms List (docx 24kb)

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

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

Agreement Forms (for WSDOT use - contact your LAC for information/use)
224-076EF:  Government Agreement for Aid (for Highway, Road and Street Purposes) (pdf 227kb)

224-105:  EF Project Review Reimbursable Agreement (J Agreement) (pdf 149kb)

Appraisal Forms

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

RES-210:  Market Data Sheet (docx 27kb)

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

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

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


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 33kb)

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

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


Certification Forms
LPA-383:  No Right of Way Certificate (docx 17kb)

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)


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-505a: Notice of Eligibility, Entitlements, and 90-Day Assurance (Non-Residential Fixed Payment) (docx 20kb)

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-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)