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Generic Relocation Assistance Forms

Relocation Assistance Program
Generic Form Revisions

WSDOT made changes to our generic relocation assistance forms August 2013. These forms are generic in nature and should be used by local public agencies instead of using the WSDOT forms

Please contact Danny Johnson, State Relocation Reviewer, at 360.705.7317 if you have any questions regarding the forms.

These forms are available in Microsoft Word (.docx)

Contents
Local Public Agency Forms List
(docx 24kb)

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

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)

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