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Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA)

Sandy Recovery Programs – URA Guide Form Procedures

PART VI – APPENDIX

Appendix Number Title Appendix 001 URA Applicability Screening form Appendix 002 Guide form Relocation Plan

(HUD 1378 – Appendix 34) Appendix 003 Appraisal Scope of Work

(HUD 1378 – Appendix 19) Appendix 004 Appraisal Contract

(HUD 1378 – Appendix 20) Appendix 005 Appraiser Certification

(HUD 1378 – Appendix 19) Appendix 006 Notice to Owner – Voluntary Acquisition – No E/D

(HUD 1378 – Appendix 31) Appendix 007 Notice to Owner – Voluntary Acquisition – with E/D

(HUD 1378 – Appendix 32) Appendix 008 Voluntary Acquisition – Alternative Valuation Appendix 009 Notice of Intent

(HUD 1378 – Appendix 30) Appendix 010 Notice of Just Compensation (Offer to Purchase) Appendix 011 HUD 1 Settlement Statement

(HUD – 1) Appendix 012 Title Report Appendix 013 Administrative Settlement Appendix 014 Condemnation Court Record/Case File Appendix 015 Site Occupancy Record – Residential

(HUD 1378 – Appendix 8) Appendix 016 Site Occupancy Record – Non-Residential

(HUD 1378 – Appendix 9) Appendix 017 Site Record – Photographs Appendix 018 Occupant Photo Identification Appendix 019 Resident/Occupant Interview form Appendix 020 Income Certification Appendix 021 Current Lease/Occupancy Agreement Appendix 022 Tenant paid utility bills Appendix 023 Certification – Legal Status Appendix 024 Power-of-Attorney Appendix 025 HUD Brochure - “When an Agency Acquires a Property”

(HUD – 1041 – CPD) Appendix 026 HUD Brochure “Relocation Assistance When Tenants Displaced

From Their Homes”

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Sandy Recovery Programs URA Guide Form Procedures Modified 6/21/2017

(HUD – 1042 – CPD) Appendix 027 HUD Brochure “Relocation Assistance to Displaced

Homeowner Occupants” (HUD – 1044 – CPD)

Appendix 028 Method/Manner of Notice Delivery Appendix 029 General Information Notice

Tenant Non-Displaced (HUD 1378 Appendix 29) Business Non-Displaced (HUD 1378 Appendix 2a) Tenant Displacement (HUD 1378 Appendix 3) Business Displacement (HUD 1378 – Appendix 3a)

Appendix 030 Notice of Non-Displacement – Residential Tenant (HUD 1378 – Appendix 4)

Appendix 031 Notice of Eligibility for Relocation Assistance Homeowner (HUD 1378 – Appendix 5) Residential Tenant (HUD 1378 – Appendix 6) Non-Residential (HUD 1378 – Appendix 7)

Appendix 032 90 Day Move Notice (sample) Appendix 033 Combined 90 Day and Notice of Eligibility (sample) Appendix 034 Record of Advisory Assistance/Case Log

(HUD 1378 – Appendix 10) Appendix 035 Stafford Act 414 – Correspondence Appendix 036 Stafford Act 414 – Public Notices Appendix 037 Stafford Act 414 – Web Notification Appendix 038 Option #1 – Individual Case Determination Appendix 039 Option #2(a) – Relocation Plan (sample) Appendix 040 Option #2(b) – Project-wide (sample) Appendix 041 Individual Comparable Replacement Unit Appendix 042 Selection Comparable Replacement Unit

(HUD-40061 from 1378 – Appendix 12) Appendix 043 Claim for Replacement Housing – Homeowner (90 day)

(HUD-40057 from 1378 – Appendix 13) Appendix 044 Claim for Replacement Housing – Renter

(HUD-40058 from 1378 – Appendix 14) Appendix 045 Claim for Temporary Relocation Expenses

(HUD-40030 from 1378 – Appendix 15) Appendix 046 Temporary Relocation Notice (sample)

On-site On-site Transfer Off-site Hotel

Appendix 047 Move-In Notice - Residential (HUD 1378 – Appendix 29)

Appendix 048 Tenant Rent Roll (sample) Appendix 049 Relocation Moving Reimbursement Appendix 050 Claim for Moving Expenses - Residential

(HUD-40054 from 1378 – Appendix 11) Appendix 051 Section 104(d) One-for-One Unit Replacement Plan Appendix 052 Relocation Specialist or Program Staff Certification

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Sandy Recovery Programs URA Guide Form Procedures Modified 6/21/2017

Appendix 053 Claim for Moving Expenses – Business (HUD-40055 from 1378 – Appendix 16)

Appendix 054 Claim Payment in Lieu Actual Moving (HUD-40056 from 1378 – Appendix 17)

Appendix 055 Residential Relocation Management Report (HUD 1378 – Appendix 21)

Appendix 056 Non-Residential Relocation Management Report (HUD 1378 – Appendix 22

Appendix 057 Comparison Chart Voluntary vs. Involuntary Acquisition (HUD 1378 – Appendix 23)

Appendix 058 Acquisition Checklist (HUD 1378 – Appendix 24)

Appendix 059 Monitoring Checklist- Acquisition Appendix 060 Monitoring Checklist- Relocation

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Appendix 001 - URA Applicability Screen Form

URA Applicability Screening Form

Department_______________________________ Date:___________

Staff____________________________________ Phone:____________

Regulation Eligibility Questions (check all that apply):

Please answer the following questions to determine if project will trigger acquisition or relocation requirements under the Uniform Relocation and Real Property Policies Act of 1970 (URA)

1. Will Federal Funds be used for the project? (Y/N) ________

2. Will the project require acquisition, rehabilitation or demolition? (Y/N) ________

Note: If the answer to both Eligibility Questions is YES, continue to the next section below. Otherwise, the URA regulations and requirements do not apply to the project, proceed to sign and date the form.

Required Project Information

3. Name of Project Sponsor/Owner/Developer:__________________________________________

4. Provide amount of Community Development Block Grant-Disaster Recovery (CDBG-DR)

$_____________________________

5. Is property occupied? (Y/N) ______________

6. Type of occupant: Residential Business/Commercial Non profit organization Church Farm Other

7. Has a formal application been submitted? (Y/N)__________ Date_____________

8. Have funds been awarded/committed to project? (Y/N) ___________

If any of the above Eligibility Questions have been answered NO, the URA Regulation does not apply. In all cases, sign and date the form.

I, ________________________________, certify that the information listed above is true (Printed Name) and accurate to the best of my knowledge.

_________________________________________ ________________________ Signature Date

***This form must be retained in project file***

1378 CHG-11

Appendix 34

App. 34-1 [09/11]

GUIDEFORM RESIDENTIAL ANTIDISPLACEMENT AND

RELOCATION ASSISTANCE PLAN

This Residential Antidisplacement and Relocation Assistance Plan (RARAP) is prepared

by [name of jurisdiction] in accordance with the Housing and Community Development

Act of 1974, as amended; and HUD regulations at 24 CFR 42.325 and is applicable to our

CDBG, UDAG and/or HOME-assisted projects.

Minimize Displacement

Consistent with the goals and objectives of activities assisted under the Act, [jurisdiction]

will take the following steps to minimize the direct and indirect displacement of persons

from their homes: (The steps provided below are examples only, each jurisdiction must

determine the actions it will take based on local needs and priorities.)

Evaluate housing codes and rehabilitation standards and code enforcement in

reinvestment areas to prevent undue financial burden on established owners and

tenants.

Stage rehabilitation of apartment units to allow tenants to remain in the

building/complex during and after the rehabilitation, working with empty units

first.

Arrange for facilities to house persons who must be relocated temporarily during

rehabilitation.

Adopt policies to identify and mitigate displacement resulting from intensive

public investment in neighborhoods.

Adopt policies which provide reasonable protections for tenants faced with

conversion to a condominium or cooperative.

Adopt tax assessment policies, such as deferred tax payment plans, to reduce

impact of increasing property tax assessments on lower income owner-occupants

or tenants in revitalizing areas.

Establish counseling centers to provide homeowners and tenants with information

on assistance available to help them remain in their neighborhood in the face of

revitalization pressures.

Where feasible, give priority to rehabilitation of housing, as opposed to

demolition, to avoid displacement.

If feasible, demolish or convert only dwelling units that are not occupied or

vacant occupiable dwelling units (especially those units which are “lower-income

Appendix 002- Guide Form Relocation Plan

1378 CHG-11

Appendix 34

[09/11] App. 34-2

dwelling units” (as defined in 24 CFR 42.305)) or structures that have not been

used for residential purposes.

Target only those properties deemed essential to the need or success of the

project.

Relocation Assistance to Displaced Persons

[Jurisdiction] will provide relocation assistance for lower-income tenants who, in

connection with an activity assisted under the [CDBG and/or HOME] Program[s], move

permanently or move personal property from real property as a direct result of the

demolition of any dwelling unit or the conversion of a lower-income dwelling unit in

accordance with the requirements of 24 CFR 42.350. A displaced person who is not a

lower-income tenant, will be provided relocation assistance in accordance with the

Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as

amended, and implementing regulations at 49 CFR Part 24.

One-for-One Replacement of Lower-Income Dwelling Units

The [jurisdiction] will replace all occupied and vacant occupiable lower-income dwelling

units demolished or converted to a use other than lower-income housing in connection

with a project assisted with funds provided under the [CDBG and/or HOME] Program[s]

in accordance with 24 CFR 42.375.

Before entering into a contract committing [jurisdiction] to provide funds for a project

that will directly result in demolition or conversion of lower-income dwelling units,

[jurisdiction] will make public by [describe how, such as publication in a newspaper of

general circulation] and submit to the HUD Field Office[the State, under the State CDBG

and/or HOME Program(s)] the following information in writing: NOTE: See guidance

in Handbook 1378, paragraph 7-5.

1. A description of the proposed assisted project;

2. The address, number of bedrooms, and location on a map of lower-income

dwelling units that will be demolished or converted to a use other than as lower-

income dwelling units as a result of an assisted project;

3. A time schedule for the commencement and completion of the demolition or

conversion;

4. To the extent known, the address, number of lower-income dwelling units by size

(number of bedrooms) and location on a map of the replacement lower-income

housing that has been or will be provided. NOTE: See also 24 CFR 42.375(d).

1378 CHG-11

Appendix 34

App. 34-3 [09/11]

5. The source of funding and a time schedule for the provision of the replacement

dwelling units;

6. The basis for concluding that each replacement dwelling unit is designated to

remain a lower-income dwelling unit for at least 10 years from the date of initial

occupancy; and

7. Information demonstrating that any proposed replacement of lower-income

dwelling units with smaller dwelling units (e.g., a 2-bedroom unit with two 1-

bedroom units), or any proposed replacement of efficiency or single-room

occupancy (SRO) units with units of a different size, is appropriate and consistent

with the housing needs and priorities identified in the HUD-approved

Consolidated Plan and 24 CFR 42.375(b).

To the extent that the specific location of the replacement dwelling units and other data in

items 4 through 7 are not available at the time of the general submission, [jurisdiction]

will identify the general location of such dwelling units on a map and complete the

disclosure and submission requirements as soon as the specific data is available.

Replacement not Required Based on Unit Availability

Under 24 CFR 42.375(d), the [jurisdiction] may submit a request to HUD (or to the State,

if funded by the State) for a determination that the one-for-one replacement requirement

does not apply based on objective data that there is an adequate supply of vacant lower-

income dwelling units in standard condition available on a non-discriminatory basis

within the area.

Contacts

The [name and phone number of the office] is responsible for tracking the replacement of

lower income dwelling units and ensuring that they are provided within the required

period.

The [name and phone number of the office] is responsible for providing relocation

payments and other relocation assistance to any lower-income person displaced by the

demolition of any dwelling unit or the conversion of lower-income dwelling units to

another use.

1378 CHG-8Appendix 19

U.S. Department of Housing and Urban Development (HUD)

Guide for Preparing An Appraisal Scope of Work

The Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA) and its implementing regulations (49 CFR Part 24) set forth minimum requirements for real property acquisition appraisals for Federal and federally-assisted programs. Appraisals subject to the URA must be prepared according to these requirements. The acquiring agency may also have additional supplemental appraisal requirements which may be attached.

The acquiring agency has a legitimate role in contributing to the appraisal process, especially in developing the scope of work and defining the appraisal problem. The scope of work and development of an appraisal under these requirements depends on the complexity of the appraisal problem

The scope of work is a written set of expectations that form an agreement or understanding between the appraiser and the agency as to the specific requirements of the appraisal, resulting in a report to be delivered to the agency by the appraiser. It includes identification of the intended use and intended user; definition of fair market value; statement of assumptions and limiting conditions; and certifications. It should specify performance requirements, or it should reference them from another source, such as the agency’s appraisal procedural manual. The scope of work must address the unique, unusual and variable appraisal performance requirements of the appraisal. Either the appraiser or the agency may recommend modifications to the initial scope of work, but both parties must approve changes.

SCOPE OF WORK: The appraiser must, at a minimum:

1. Provide an appraisal meeting the definition of an appraisal found at 49 CFR 24.2(a)(3).

2. Afford the property owner or the owner’s designated representative the opportunity toaccompany the appraiser on the inspection of the property.

3. Perform an inspection of the subject property. The inspection should be appropriate for theappraisal problem, and the scope of work should address:

• The extent of the inspection and description of the neighborhood and proposedproject area,

• The extent of the subject property inspection, including interior and exterior areas,

• The level of detail of the description of the physical characteristics of the propertybeing appraised (and, in the case of a partial acquisition, the remaining property),

4. In the appraisal report, include an adequate description of the physical characteristics ofthe property being appraised (i.e., sketch of the property and provide the location anddimensions of any improvements) and a description of comparable sales. The appraisal reportshould also include adequate photographs of the subject property and comparable sales, andprovide location maps of the property and comparable sales

5. In the appraisal report, include items required by the acquiring agency, including but notlimited to the following:

App. 19-1 [03/07]

Appendix 003- Appraisal Scope of Work

1378 CHG-8 Appendix 19

• Property right(s) to be acquired, e.g., fee simple, easement, etc.,

• Value being appraised (usually fair market value), and its definition

• Appraised as if free and clear of contamination (or as specified),

• Date of the appraisal report and the date of valuation,

• A realty/personalty report as required by 49 CFR 24.103(a)(2)(i),

• Known and observed encumbrances, if any,

• Title information,

• Location,

• Zoning,

• Present use, and

• At least a 5-year sales history of the property.

6. In the appraisal report, identify the highest and best use. If highest and best use is inquestion or different from the existing use, provide an appropriate analysis identifying themarket-based highest and best use.

7. Present and analyze relevant market information. (Specific requirements for marketinformation should be included in the agency’s appraisal procedural manual and shouldinclude research, analysis, and verification of comparable sales. Inspection of thecomparable sales should also be specified.)

8. In developing and reporting the appraisal, disregard any decrease or increase in the fairmarket value of the real property caused by the project for which the property is to beacquired, or by the likelihood that the property would be acquired for the project. (Ifnecessary, the appraiser may cite the Jurisdictional Exception or Supplemental StandardsRules under USPAP to ensure compliance with USPAP while following this and otherUniform Act requirements.)

9. Report his or her analysis, opinions, and conclusions in the appraisal report.

ADDITIONAL REQUIREMENTS FOR A SCOPE OF WORK:

INTENDED USE: This appraisal is to estimate the fair market value of the property, as of the specified date of valuation, for the proposed acquisition of the property rights specified (i.e., fee simple, etc.) for a Federally assisted project.

INTENDED USER: The intended user of this appraisal report is primarily the acquiring agency, but its funding partners may review the appraisal as part of their program oversight activities.

App. 19-2 [03/07]


DEFINITION OF FAIR MARKET VALUE: This is determined by State law. Fair market value, however, is generally defined as the price that a seller is willing to accept and a buyer is willing to pay on the open market in an arm’s length transaction, and usually includes the following:

1. Buyer and seller are typically motivated;

2. Both parties are well informed or well advised, each acting in what he or she considers hisor her own best interest;

3. A reasonable time is allowed for exposure in the open market;

4. Payment is made in terms of cash in U. S. dollars or in terms of financial arrangementscomparable thereto; and

5. The price represents the normal consideration for the property sold unaffected by special orcreative financing or sales concessions granted by anyone associated with the sale.

CERTIFICATION: The appraisal shall include a certification of the appraiser (see attached sample or insert agency’s certification).

ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser shall state all relevant assumptions and limiting conditions. In addition, the acquiring agency may provide other assumptions and conditions that may be required for the particular appraisal assignment, such as:

• The data search requirements and parameters that may be required for the project.

• Identification of the technology requirements, including approaches to value, to beused to analyze the data.

• Need for machinery and equipment appraisals, soil studies, potential zoning changes,etc.

• Instructions to the appraiser to appraise the property "As Is" or subject to repairs orcorrective action.

• As applicable include any information on property contamination to be provided andconsidered by the appraiser in making the appraisal.

App. 19-3 [03/07]

Handbook 1378

Appendix 20

App. 20-1 9/90

AGREEMENT FOR APPRAISAL SERVICES (ACQUISITION)

THIS AGREEMENT entered into this _________ day of __________, 19___,

by and between ____________________________________________ of the City of

_______________________________________________________________, State of

__________________________, hereinafter referred to as the "Agency," and

_____________________________________, hereinafter referred to as the

"Appraiser."

WITNESSETH THAT:

WHEREAS, the Agency proposes to acquire certain real property and

desires that the Appraiser furnish the Agency certain services with respect

to such property, including an appraisal of each parcel of the property,

and the Appraiser represents that he or she is fully qualified to perform

such services and will furnish such services personally; and

WHEREAS the services to be provided under this Agreement are necessary to

achieve the purposes of _____________________________________ and the Uniform

Relocation Assistance and Real Property Acquisition Policies Act of 1970, as

amended (URA).

NOW, THEREFORE, the Agency and the Appraiser, for the consideration and

under the conditions hereinafter set forth, do agree as follows:

ARTICLE 1. Property To Be Appraised.

A description of the real property to be appraised, including an

identification of any interests in the real property to be specifically

excluded from appraisal, are set forth in the attached Exhibit A. A separate

appraisal is to be furnished for each "parcel." (The term "parcel" means any

tract or contiguous tracts of land in the same ownership, whether any such

tract consists of one or more platted lots or a fractional part of a lot. An

easement or other separately held interest in two or more parcels shall be

considered to be a separate parcel for appraisal purposes and an exception to

the title to the parcels so encumbered. An easement in a parcel that is

appurtenant to another parcel to be acquired by the Agency shall be

considered to be part of such other parcel and an exception to the title of

the parcel encumbered.) Each parcel shall be considered to include all right,

title, and interest of the owner in or to any adjacent or abutting streets,

alleys, or other public rights of way.

ARTICLE 2. Purpose and Basis of Valuations.

(a) Purpose and Significance of Appraisals. The appraisals to be

furnished under this agreement are required by the Agency for its guidance

in making fair and impartial determinations of fair market value and

the just compensation to be offered to each property owner. The Appraiser

shall be guided by those objectives when estimating values. Appraisal

reports will be reviewed carefully by the Agency. Accordingly, the text of

each appraisal report must cover all matters germane to the required

valuation findings and must provide a full explanation of the Appraiser's

reasoning and his analyses of the evidences of value, so that a reviewer

Appendix 004- Appraisal Contract

Handbook 1378

Appendix 20

9/90 App.20-2

will be able to follow the Appraiser's analyses and understand how he

reached his valuation conclusions.

(b) Appraisal Standards. The appraisals under this agreement shall

be based on nationally recognized appraisal standards and techniques to the

extent that such principles are consistent with the concepts of value

and the rules on the admissibility of evidence of value under the eminent

domain law of the State. Factors relating to race, color, religion, sex

or national origin, or to racial, religious or ethnic identification of

neighborhoods are not relevant to the estimation of value and shall not be

considered in connection with appraisals of residential real property.

(c) Date of Valuation. The Appraiser's valuation shall be as of a

date concurrent with the preparation of the report unless the Agency has

specified some other date of valuation.

(d) Relocation Assistance. The Appraiser's analyses and opinions

of property value shall not reflect any allowance for the relocation

payments and other assistance provided under the URA.

(e) Influence of Project on Property Value. In forming opinion(s),

the Appraiser shall disregard any decrease or increase in the fair market

value of the real property to be acquired, prior to the date of valuation,

caused by the project for which the property is to be acquired, or by the

likelihood that the property would be acquired for such project, other than

that due to physical deterioration within the reasonable control of the

owner. (In the case of a partial acquisition, using the before-and-after

method of valuation, the Appraiser's opinion of the value of the remaining

not-to-be-acquired portion of the property shall reflect any increase or

decrease in value attributable to the project.) If the determination of

changes in value caused by the project is a problem, the Appraiser's report

shall cite the ruling followed and its source and shall explain the effect

of the ruling on his opinion of value.

ARTICLE 3. Scope of Appraiser's Services.

The Appraiser agrees to perform the following services:

(a) Appraise each parcel and prepare and deliver to the Agency,

within ______________ calendar days after the date of this agreement,

____ copies of the appraisal report(s) conforming to the provisions of this

agreement. The Appraiser shall personally inspect each parcel, including

all buildings, structures, fixtures, and other improvements to the

property. The Appraiser shall give the owner or his designated

representative an opportunity to accompany the Appraiser during his

detailed inspection of the property. If the owner of a compensable

interest in the property or a representative of such owner does not

accompany the Appraiser during the inspection, the Appraiser shall include

in his appraisal report a copy of his notification to the owner of the

opportunity to accompany the Appraiser and evidence of the owner's receipt

of such notification. In the process of inspecting the property, the

Appraiser shall, to the extent practicable, ascertain the rights of all

parties in possession and note for consideration all factual information

and comments furnished by the owner or his representative relevant to the

appraisal.

Handbook 1378

Appendix 20

App. 20-3 9/90

(b) Testify as an expert witness in behalf of the Agency in any

judicial proceeding involving any property appraised under this agreement.

Such services shall include such reasonable time as may be required for

reinspection of the property, updating the Appraiser's valuation,

participation in pretrial conferences with counsel for the Agency, and

testifying in the judicial proceeding. The compensation for such services

shall be determined in accordance with Article 6.

(c) Modify or furnish supplements to any appraisal report furnished

under this agreement, without additional cost to the Agency, if (1)

applicable principles of law with respect to the valuation of the property

require the modification or supplementing of such appraisal, (2) material

omissions, inaccuracies, or defects in the appraisal report are discovered

after delivery and acceptance of the report by the Agency, or (3) the

Appraiser receives or becomes aware of relevant additional appraisal

information in existence prior to the date the Appraiser signed the report.

If there is a significant delay between the date of valuation and the date

of acquisition of any parcel or if the property has been materially altered

since the appraisal by a fire, a revised determination of the boundaries of

the property to be acquired, or other cause, the Appraiser shall, if

requested by the Agency, furnish the Agency a supplementary report updating

this valuation and the supporting data and analyses to a current date. The

compensation for such updating of an appraisal shall be determined in

accordance with Article 6.

(d) Estimate the value of any right or interest proposed to be

reserved by the owner in a property appraised by the Appraiser, such as an

easement for access to other property of the owner, the right to

continue occupancy for an extended period after the Agency acquires the

property, or the right to remove any building, structure, fixture, or other

improvement. The compensation to be paid to the Appraiser for furnishing

any such valuation shall be determined in accordance with Article 6.

(e) Consult with the Agency and its legal counsel regarding

services to be performed by the Appraiser, at such time(s) as may be

mutually convenient for the parties to this agreement. The Appraiser shall

initiate such consultations whenever the Appraiser is in doubt as to

whether an element of property is real or personal property or needs legal

advice on any aspect of the appraisals to be furnished under this

agreement. There shall be no charge by any party for such consultations.

ARTICLE 4. Contents of Appraisal Reports.

Each appraisal report to be furnished by the Appraiser under this agreement

shall contain certain information and the Appraiser's conclusions and

opinions, together with the data and analyses by which they were derived, as

set forth below. A separate report shall be submitted for each parcel.

However, if more than one parcel is to be appraised, all general data may be

included in a separate data volume that is referenced in the separate

appraisal reports on the individual parcels. The appraisal report on each

parcel shall include the following:

(a) A summary headed "Appraisal Report for ______________________" that

provides the following:

(1) Project name and number.

Handbook 1378

Appendix 20

9/90 App.20-4

(2) Date of the report.

(3) Parcel number, address of the property, brief identification of all

interests in the property appraised, and the name of the owner(s)

including any tenant-owners.

(4) Date(s) of the Appraiser's inspection of the property with the owner

or the owner's designated representative. Include the name of each owner

or representative of an owner who accompanied the Appraiser during the

inspection and the interest held in the property or the representative

capacity of each such person.

(5) The Appraiser's estimate of the fair market value of the entire

parcel and the fair market value of the same interest in the land, as if

vacant.

(6) The limiting conditions of the appraisal, which may include

assumptions (i) that the title is good and marketable, (ii)that no

responsibility is assumed by the Appraiser for legal matters, especially

those affecting the title to the property, (iii) that the legal

description of the property and the interest in the property to be

appraised, furnished to the Appraiser by the Agency, is correct, and (iv)

that no survey of the property has been made. Any other appropriate

assumption or limiting condition may be added if it has been specifically

approved in writing by the Agency.

(7) The certifications of the Appraiser (i) that the Appraiser personally

made a thorough inspection of the property, (ii)that, to the best of the

Appraiser's knowledge and belief, everything contained in the report is

true and no relevant and important fact has been omitted, (iii) that

neither the Appraiser's employment nor compensation is contingent on the

valuation reported, and (iv) that the Appraiser has no past, present, or

prospective interest (including that of real estate agent or broker) in

the property, the parties involved, or any other interest that would

conflict in any way with the services performed or the making of an

impartial report.

(8) A certification that, in the Appraiser's opinion, the fair market

value of the property is an amount to be stated as of the date of

valuation.

(9) The signature of the Appraiser.

(b) The name and address of the owner of the property and the name

and the address, if known, of any other party known or believed to hold a

separate compensable interest in the property.

(c) The street address and an accurate description of each parcel and all

interests in the parcel appraised. The property description shall identify

all conditions, restrictions, easements, servitudes, and reservations

affecting the title. The property description shall specifically exclude and

describe any separately held interest in the property that is to be acquired

separately or as part of another parcel. The description shall also

specifically exclude all separately held interests which are not to be

Handbook 1378

Appendix 20

App. 20-5 9/90

acquired and will not be affected adversely by the Agency's project. If there

are any separately held interests in a parcel, which are to be acquired with

other interests in the same parcel, such as leaseholds, tenant-owned

improvements, life estates, easements, and water, gas, oil, or mineral

rights, a description of each such separate interest and the name of its

owner shall be furnished.

(d) Off-record title information concerning interests or instruments that

affect title, but are not of record, such as leases, options to renew a

lease, contracts of sale, and other interests or rights of parties in

possession. Such information shall be reported, and if available facts are

sufficient, the Appraiser's report shall be based on such additional title

information and so noted in the appraisal report. Otherwise, the Appraiser

shall refer the matter to the Agency and defer completion of the appraisal

until the question is resolved.

(e) Basic property data including pertinent information with respect to

such matters as (1) the environment and location of the property, (2) the

zoning and any restrictive covenants, conditions, or servitudes affecting the

available use or occupancy of the land, (3) the assessed value of the real

property and the current annual real estate tax burden, (4) the use and

occupancy of the property at time of appraisal, (5) the public improvements,

services, and utilities serving and providing access to the property, (6) the

character, topography, dimensions, and area of the land, (7) the freedom of

the property from special hazards, (8) the current rental and rental history

of the property, if rented, (9) the estimated annual costs of ownership and

for operation and maintenance of the property, and (10) a description of the

buildings, structures, and other improvements, if any, including relevant

information as to type of improvement, designed use, construction materials

and finish, equipment, dimensions, floor area, age, condition, space or room

arrangement, functional utility, and any other characteristics or attributes

of the improvements germane to the value of the real property. The appraisal

report shall contain a general sketch plat showing the shape and dimensions

of the land, the location of the principal improvements on the land, the

location of any easements in the land, and the abutting streets, alleys, or

other public rights of way. The report shall also include such photographs,

each clearly identified, as may be appropriate.

(f) Report of any condition or occupancy of the property in violation of

law that may affect the value of the property.

(g) The Appraiser's opinion as to the highest and best use for the

property. The appraisal report shall also include the Appraiser's opinions as

to any other use(s) for which the property is reasonably suitable or

adaptable. If the property is unused vacant land or the highest and best use

is not self-evident or is found to differ significantly from the present use,

the appraisal report shall contain the analyses by which the Appraiser

reached the conclusions as to the highest and best use of the property and as

to its suitability or adaptability for any other use(s). The analysis of a

potential use shall include consideration of relevant matters, such as the

suitability of the location, the environment and the legal and physical

attributes of the property for such use, the estimated cost, if any, of

converting the property to such use, and the supply, sale price levels, and

relative desirability of other properties that would compete for the same

kind of use. The analysis of the property for the future use or uses found to

be the highest and best use is part of the process of appraising the property

Handbook 1378

Appendix 20

9/90 App.20-6

and, therefore, may be included in the valuation analysis furnished in

accordance with Paragraph 4(h) below.

(h) The opinion of the Appraiser as to the fair market value of the

property. The appraisal report shall contain a description of the reasoning

process used by the Appraiser in reaching the conclusion as to value and all

data and analyses needed to explain and support the valuation. The supporting

data and analyses furnished in the appraisal report shall include the

following:

(1) An analysis of the property, from the point of view of evaluating

the effect of its characteristics and attributes on its value for the

available use or uses for which the property is best suited. Particular

attention shall be given to the characteristics of the property most

relevant to its value, such as, in the case of an investment property,

the income potential and the expenses of ownership, maintenance, and

operation.

(2) An identification of the most recent sale of each property

appraised and any other sales of such property during the last five (5)

years preceding the appraisal. Such sale(s) of the property appraised

and all recent sales of comparable properties considered by the

Appraiser in forming the opinion(s) of fair market value shall be

verified insofar as practical. The information furnished with respect

to each such sale shall include, among other pertinent facts, the names

of the grantor and grantee, the date of the sale, the sale price, any

special terms or conditions or circumstances of the sale that affected

the transaction, and a description of the property and its condition at

time of sale in sufficient detail for use in making the appraisal.

(3) The analyses that constitute the principal basis for the

Appraiser's opinion of the fair market value. The appraisal report

shall contain the Appraiser's evaluation with respect to previous sales

of the property appraised and any recent offer of the owner to sell the

property. The appraisal report shall also contain the Appraiser's

analysis of each comparable property and its sale in relation to the

property appraised. The Appraiser's analysis shall reflect appropriate

allowances for the difference in the time of the sale of the comparable

properties and the date of appraisal and the differences in the

utility, desirability, and productivity of the properties that are

pertinent to their relative value. The appraisal report shall contain a

valuation data map showing the location of the property appraised and

the comparable properties referred to in the appraisal report.

(4) All other information, analyses, and estimates considered by the

appraiser to be relevant to the estimation of the fair market value of

the property.

(5) If the property appraised is part of a larger parcel in the same

ownership or is less than the entire interest of the owner in the

property, the appraisal report shall contain the Appraiser's opinion of

just compensation for a taking of such property or interest, using the

before-and-after method of valuation as interpreted under State law

unless it is obvious that there would be no damages or benefits to the

remaining property or interest of the owner. However, if the part or

interest to be taken is such a small part of the whole property that

the damages for the taking can be more accurately estimated directly,

Handbook 1378

Appendix 20

App. 20-7 9/90

that method may be used if permitted under State law, without

estimating the fair market value of the entire property of the owner.

The foregoing opinions of the Appraiser shall be supported in the

report by the data and analyses by which the Appraiser reached his/her

conclusions.

For information purposes, the appraisal report shall also contain the

Appraiser's estimates of the fair market value of the to-be-acquired

part or interest as part of the whole property and the net damages or

benefits to the remaining property of the owner. If in the opinion of

the Appraiser, acquisition of the part of, or interest in, the property

proposed for acquisition would leave the owner with an uneconomic

remnant, the Appraiser shall furnish a separate estimate of the fair

market value of a "parcel" comprising both the parcel proposed for

acquisition and the uneconomic remnant. (A remainder parcel or interest

shall be considered to be an uneconomic remnant if by itself it has

little or no utility or value to the owner.)

(6) Such maps, plans, photographs, or other exhibits as are necessary

to explain or illustrate the analyses of the Appraiser.

(7) The Appraiser's evaluation of the indications of value deduced from

the separate analyses of the various evidences of value and an

explanation of how the Appraiser reached his/her final conclusion as to

the fair market value of the property.

(i) The opinion of the Appraiser as to the fair market value of the

land, as if vacant. The valuation shall be for the same interest in the

land as is to be acquired in the real property. The report shall contain

information with respect to the available use or uses for which the land

would be suitable if vacant, the opinion of the Appraiser as to its highest

and best use, and the Appraiser's analysis of the evidences of value and of

the use potential by which the Appraiser reached his/her conclusions as to

the highest and best use of the land and the land value.

(j) A property analysis if the property is a commercial, industrial,

institutional, governmental, or farm property that involves substantial

quantities and kinds of fixtures such as machinery and equipment. Any

building, structure, fixture, or other improvement, which would be real

property if owned by the owner of the land, shall be considered to be real

property (even if the improvement is the property of a tenant who has the

right to remove it or the obligation to remove it at the expiration of the

lease term). The property analysis must be approved by the Agency before the

appraisal is completed and, as approved by the Agency, shall be included as

an exhibit in the Appraiser's report. The property analysis shall list,

identify, and classify as to ownership and type of improvement, all items of

physical property considered to be part of the real property. The property

analysis shall also identify tangible personal property located on the

premises to the extent reasonably necessary to prevent misunderstandings as

to what is regarded as being real or personal property. Buildings,

structures, fixtures and other improvements, including their accessories and

spare parts, shall be identified and classified as to ownership and type of

property as follows:

(1) Ownership.

Handbook 1378

Appendix 20

9/90 App.20-8

(i) Owner of the land.

(ii) Each tenant in occupancy.

(iii) Each non-occupant owner of any fixtures or other

improvements, or personal property on the premises.

(2) Type of property

(i) Building, structure, or fixed improvement.

(ii) Building equipment, removable.

(iii) Fixtures, classified as to whether economically removable

for reuse, removable for salvage only, or irremovable.

(iv) Personal property, identified as to types and approximate

amounts, or otherwise, as needed to prevent misunderstandings as

to the classification of any item.

If any building, structure, fixture or other improvement is not to be

acquired, will not be adversely affected by the Agency's project, and will

not be required by the Agency to be removed, such as a pipeline in an

easement not to be acquired, such improvement shall be identified as

excluded from the appraisal.

(k) If machinery and equipment or other fixtures used in a trade or

business, farm operation, or institutional or governmental function

constitute part of the real property, the appraisal report shall contain a

separate schedule which provides separate estimates for each such item, as

prescribed below. If there is more than one owner of such items, a

separate schedule shall be furnished for each owner. The information and

conclusions to be furnished on each item are as follows:

(1) Description of the item, including, as appropriate, the

manufacturer, model and serial number, size or capacity, age and

condition, and degree of obsolescence. Accessories and spare parts,

special foundations, and power wiring and process piping generally

shall be listed separately, following the listing of the item(s) to

which they apply.

(2) Estimate of the replacement cost installed of the item as listed

and identified (excluding any elements listed separately). Separately

identify the basis of estimated replacement cost (new or used).

(3) The contributive (enhancement) value of the item to the fair market

value of the real property as a whole.

(4) Estimated fair market value of the item for removal from the

property at a purchaser's expense. Such value shall be considered to be

the probable selling price if the item were offered for sale for

removal from the property at the purchaser's expense, allowing a

reasonable time to find a purchaser buying with knowledge of the uses

and purposes for which it is adaptable and capable of being used,

Handbook 1378

Appendix 20

App. 20-9 9/90

including salvage for serviceable components and scrap when it appears

that will provide the highest value.

The schedule(s) of estimates shall be consistent with the property

analysis approved by the Agency, as provided in Paragraph 4(j). The Appraiser

is permitted to use the services of such technical specialists as may be

needed to enable the Appraiser to provide valid estimates and sound

valuations. The schedule(s) shall be supported by an explanation of the

procedures followed in gathering the necessary market information and

technical data. The principal purpose of the Appraiser's accompanying

narrative, however, must be to explain his analyses and his evaluations of

the dollar amount of the overall contribution of the machinery, equipment,

and fixtures to the fair market value of the real property as a whole. The

report shall contain any layout plans, sketches, or photographs that are

reasonably necessary for locating or identifying the facilities or

illustrating the Appraiser's analyses.

(l) If there are separately held interests in the real property to be

acquired, such as easements, leaseholds, air rights, life estates, and oil,

gas, or mineral rights, and the division of ownership is not of such

character as to destroy the practical unity of the property, the Appraiser

shall apportion his estimate of the fair market value of the property (all

interests in the property to be acquired) to each separately held interest.

(However, tenant-owned improvements shall be valued in accordance with

Paragraph 4(m) below.) The report shall contain the data, analyses, and

reasoning by which the Appraiser made the apportionment. If the "unit

rule" is regarded as not applicable because the division of ownership is

such as to diminish the fair market value of the property as a whole, the

separate interests involved shall be appraised separately.

(m) Tenant-owned improvements. If any building, structure, fixture, or

other improvement to the property is identified as being the property of a

tenant who has the right or obligation to remove it at the expiration of the

lease term, the Appraiser's estimate of the fair market value of the

improvement shall be the greatest of (1) the amount which the improvement

contributes to the fair market value of the property, (2) the in-place value

of the improvement as part of the real property (the depreciated replacement

cost of the improvement installed), or (3) the fair market value of the

improvement for removal from the property at the purchaser's expense. The

appraisal report shall state the basis for the valuation of the improvement

and furnish the data and analyses on which the valuation was made.

(n) If the property is a multifamily or mixed-use (residential and

nonresidential) property and an owner of a compensable interest in the

property also occupies a dwelling in the property, the Appraiser shall

furnish an apportionment of the estimate of the fair market value of the

whole property to such dwelling and to the remainder of the property. For

the purpose of this paragraph, an occupant of a dwelling shall be

considered to own a compensable interest in the property if he or she holds

fee title, a life estate, a 99-year lease, or a lease with not less than 50

years to run from the date of valuation, or holds an interest in a

cooperative housing project which includes the right to occupy the

dwelling, or is the contract purchaser of any of the foregoing estates or

interests, or has a leasehold interest with option to purchase. The

Appraiser's report shall explain how the apportionment was made.

Handbook 1378

Appendix 20

9/90 App.20-10

ARTICLE 5. Services To Be Provided by Agency.

The Agency agrees to furnish the Appraiser the following:

(a) A map or plat, based on official records, of the property described

in Article 1, showing the boundaries and dimensions of the parcels to be

appraised. Each parcel shall be designated by a number, and the parcel

numbers shown on the Appraiser's reports shall correspond to the parcel

numbers shown on the map or plot. However, additional parcel numbers may be

assigned by the Appraiser for easements appraised separately or for

additional parcels revealed while making the appraisals. The Appraiser shall

promptly advise the Agency of any such additions.

(b) An ownership data report for each parcel. That report will show all

estates and interests in the parcel as shown of record and consequently shall

not be assumed to accurately define the interests to be appraised. The

ownership data report on each parcel as shown on the parcel map will include:

(1) The name (and address, if available) of the owner appearing on

record;

(2) The legal description of the parcel as shown by the conveyance(s)

by which the record owner acquired title;

(3) Identification of the conveyance(s) by which the present owner

acquired title, including: the date of the conveyance(s); the date,

book and page numbers, and place of recordation; the name (and the

address, if available) of the grantor of such conveyance; the stated

consideration; the amount of any mortgages or encumbrances placed of

record or to which title was subject at time of conveyance (so far as

determinable from an examination of the conveyance); and the amount of

any State or local transfer taxes that were based on the amount of the

consideration;

(4) Outstanding estates and other rights or interests of record,

including easements, use restrictions, mineral rights, leases, and any

known, but unrecorded, interests of other parties. Sufficient

information shall be furnished to disclose the probable effect of such

outstanding interests on the title of the record owner;

(5) Outstanding special assessments, if any, for public improvements

such as streets, sidewalks, public utilities, and similar public

facilities;

(6) The amount of real estate taxes for the current year and the

assessed valuation stated separately for land and for improvements.

(c) Legal advice, upon request of the Appraiser, on legal matters

affecting the appraisal of any property to be appraised.

ARTICLE 6. Payment.

In consideration of the services provided by the Appraiser under this

agreement, the Agency agrees to make payments to the Appraiser upon the

submission to the Agency of properly certified invoices, as follows:

Handbook 1378

Appendix 20

App. 20-11 9/90

(a) For appraisal reports accepted by the Agency, and for all other

services furnished in accordance with Article 3, except services furnished

in connection with judicial proceedings under Paragraph 3(b), the updating

of appraisals under Paragraph 3(c), and the valuation of reservations of

rights in owners under Paragraph 3(d), the lump sum of ___________________

_____________________________________________________________ dollars,

which shall constitute full payment to the Appraiser for all of such

services and for all supplies, materials, and equipment used or furnished

by the Appraiser and all expenses incurred by the Appraiser in connection

with the performance of such services.

(b) For services furnished by the Appraiser in connection with judicial

proceedings as provided in Paragraph 3(b) (except services as an expert

witness in such a proceeding), the updating of appraisals as provided in

Paragraph 3(c), and the valuation of reservations of rights in owners as

provided in Paragraph 3(d), _________________________ dollars per hour or

fraction of an hour actually engaged in performing the services, including

travel time. All expenses of the Appraiser, including travel expense and

subsistence, shall be borne by the Appraiser.

(c) For services as an expert witness for the Agency in judicial

proceedings as provided in Paragraph 3(b), the Appraiser and the Agency

hereby agree that the fair and reasonable compensation for the Appraiser's

services shall be _______________________________________ dollars for each

day's attendance in court.

ARTICLE 7. Agreements of Appraiser.

As an inducement to the execution of this agreement by the Agency and in

consideration of the agreements to be performed by the Agency, the Appraiser

agrees that:

(a) Qualifications. The Appraiser is qualified to perform the services

to be furnished under this agreement and is permitted by law to perform such

services, and all personnel engaged in the work shall be qualified and so

permitted to do the work they perform. Attached as Exhibit B, is a statement

by the Appraiser, certified by the Appraiser to be true and correct, setting

forth the Appraiser's technical qualifications, general appraisal experience,

specific experience in appraising properties of the type involved in this

agreement, the courts in which he or she has testified as an expert witness,

and other information pertinent to establishing his or her technical

qualifications.

(b) Solicitation of Agreement. The Appraiser has not employed any

person to solicit this agreement and has not made and will not make any

payment or any agreement for the payment of any commission, percentage,

brokerage, contingent fee, or other compensation in connection with the

procurement of this agreement.

(c) Interest of Appraiser and Appraiser's Employees. The Appraiser does

not have any interest (including that of real estate agent or broker), direct

or indirect, present or prospective, in any property described in Article 1

or in its sale, or any other interest, whether or not in connection with the

property, which would conflict in any manner or degree with the performance

of the services and the submission of impartial reports, and has not employed

Handbook 1378

Appendix 20

9/90 App.20-12

and will not employ, in connection with the services to be furnished under

this agreement, any person having any such interest. Until the property is

acquired by the Agency or excluded from its project by resolution of its

governing body, the Appraiser and any employees of the Appraiser, so long as

they are employed by the Appraiser, will not acquire any such interests and

will not, for their own account or for other than the Agency, negotiate for

any of the property, perform services in connection with the property, or

testify voluntarily as a witness in a condemnation or other proceeding with

respect to the property.

(d) Services To Be Confidential. All services, including reports,

opinions, and information, to be furnished under this agreement are

confidential and shall not be divulged, in whole or in part, to any person,

other than to duly authorized representatives of the Agency, without prior

written approval of the Agency, except by testimony under oath in a judicial

proceeding or as otherwise required by law. The Appraiser shall take all

necessary steps to ensure that no member of the Appraiser's staff or

organization divulges any such information except as may be required by law.

(e) Facilities and Personnel. The Appraiser has and will continue to

have proper facilities and personnel to perform the services and work agreed

to be performed. If the Appraiser proposes to employ any person or persons to

make any appraisals of machinery and equipment or other specialized elements

or attributes of a property appraised under this agreement, the employment of

such person or persons for such purpose shall not place the Agency under any

obligation to such employee, nor relieve the Appraiser of full responsibility

for the faithful performance of the services to be furnished under this

agreement.

(f) Equal Employment Opportunity. During the performance of this

agreement:

(1) The Appraiser will not discriminate against any employee or

applicant for employment because of race, color, religion, sex, or

national origin. The Appraiser will take affirmative action to ensure

that applicants are employed, and that employees are treated during

employment, without regard to their race, color, religion, sex, or

national origin. Such action shall include, but not be limited to, the

following: employment, upgrading, demotion, or transfer; recruitment or

recruitment advertising; layoff or termination; rates of pay or other

forms of compensation; and selection for training, including

apprenticeship. The Appraiser agrees to post in conspicuous places,

available to employees and applicants for employment, notices to be

provided by the Agency setting forth the provisions of this

nondiscrimination clause.

(2) The Appraiser will, in all solicitations or advertisements for

employees placed by or on behalf of the Appraiser, state that all

qualified applicants will receive consideration for employment without

regard to race, color, religion, sex, or national origin.

(g) Assignment. The Appraiser's rights, obligations, and duties under

this agreement shall not be assigned in whole or in part, but this shall not

prohibit the assignment of the proceeds due under this agreement to a bank or

financial institution. This agreement may be assigned by the Agency to any

Handbook 1378

Appendix 20

App. 20-13 9/90

corporation, agency, or instrumentality having authority to accept the

assignment.

(h) Subcontracting. None of the work or services covered by this

agreement shall be subcontracted without the prior approval of the Agency.

(i) Records. The Appraiser shall maintain records of all details

with respect to the services to be performed under this agreement, including

one complete copy of each appraisal report and related notes, for

three (3) years after delivering the report or until the property is

acquired by the Agency or the acquisition is abandoned, whichever is later.

(j) Affidavits of Compliance. The Appraiser will, if requested by the

Agency, furnish the Agency affidavits certifying compliance with the

provisions of this Article 7.

ARTICLE 8. Changes.

The Agency, by written notice to the Appraiser, may modify the scope or

quantity of the services to be furnished under this agreement. If such

changes cause an increase or decrease in the amount of services to be

provided by the Appraiser or in the time required for their performance,

equitable adjustment shall be made in the provisions of this agreement for

payments to the Appraiser or for the time for performance of the services or

for both, and this agreement shall be modified by agreement of the parties

accordingly.

ARTICLE 9. Termination of Agreement for Cause.

If, through any cause, the Appraiser shall fail to fulfill in a timely and

proper manner his or her obligations under this agreement, or if the

Appraiser shall violate any of the provisions of this agreement, the Agency

may upon written notice to the Appraiser terminate the right of the Appraiser

to proceed under this agreement or with such part or parts of the agreement

as to which there has been default, and may hold the Appraiser liable for any

damages caused to the Agency by reason of such default and termination. In

the event of such termination, any completed reports prepared by the ppraiser

under this agreement shall, at the option of the Agency, become its property

and the Appraiser shall be entitled to receive equitable compensation for any

work completed to the satisfaction of the Agency. The Appraiser, however,

shall not thereby be relieved of liability to the Agency for damages

sustained by the Agency by reason of any breach of the agreement by the

Appraiser, and the Agency may withhold any payments from the Appraiser for

the purpose of setoff until such time as the amount of damages due the Agency

from the Appraiser is determined. The Appraiser shall not be held liable for

damages under this Article solely for reasons of delay if the delay is due to

causes beyond his or her control and without his or her fault or negligence,

but this shall not prevent the Agency from terminating this agreement because

of such delay.

ARTICLE 10. Interest of Members of Agency.

No member of the Agency shall participate in any decision relative to this

agreement affecting, directly, or indirectly, his or her personal interests.

No such member and no other officer, agent or employee of the Agency having

any responsibility or function in connection with this agreement shall have

Handbook 1378

Appendix 20

9/90 App.20-14

any private interest, direct or indirect, in this agreement or the proceeds

of this agreement.

ARTICLE 11. Officials Not To Benefit.

No Member of or Delegate to the Congress of the United States of America, and

no Resident Commissioner, shall be admitted to any share or part of this

agreement or to any benefit to arise from the same.

ARTICLE 12. Notices.

Any action by the Agency under this agreement may be taken by

____________________________, or such other person(s) as the Agency may, by

written notice to the Appraiser, designate for such purpose. All notices to

the Appraiser shall be considered to be properly given if mailed to the

address specified below, or delivered personally to the Appraiser. All

notices or other papers given to the Agency shall be considered to be

sufficiently given if mailed, postage prepaid to ___________________________,

at ___________________________________________________ or to such other

representative or address as the Agency may designate to the Appraiser in

writing.

IN WITNESS WHEREOF, the Agency and the Appraiser have executed this

agreement on or as of the date first above written.

________________________________________

(Appraiser)

________________________________________

(Street Address)

________________________________________

(City) (State) (Zip code)

________________________________________

(Agency)

By:

________________________________________

________________________________________

(Title)


CERTIFICATE OF APPRAISER - SAMPLE

I hereby certify:

That on __________________ date(s), I personally made a field inspection of the property herein appraised and have afforded the owner or a designated representative the opportunity to accompany me on this inspection. I have also personally made a field inspection of the comparable sales relied upon in making said appraisal. The property being appraised and the comparable sales relied upon in making this appraisal were as represented in the appraisal.

That to the best of my knowledge and belief the statements contained in the appraisal herein set forth are true, and the information upon which the opinions expressed therein are based is correct; subject to the limiting conditions therein set forth.

That I understand that such appraisal may be used in connection with the acquisition of property for a project utilizing U.S. Department of Housing and Urban Development funds.

That such appraisal has been made in conformity with appropriate laws, regulations, and policies and procedures applicable to appraisal of property for such purposes; and that to the best of my knowledge no portion of the value assigned to such property consists of items which are noncompensable under the established law of said State.

That any decrease or increase in the fair market value of real property prior to the date of valuation caused by the project for which such property is acquired, or by the likelihood that the property would be acquired for such project, other than that due to physical deterioration within the reasonable control of the owner, was disregarded in determining the compensation for the property.

That neither my employment nor my compensation for making this appraisal and report are in any way contingent upon the values reported herein.

That I have no direct or indirect present or contemplated future personal interest in such property or in any benefit from the acquisition of such property appraised.

That I have not revealed the findings and results of such appraisal to anyone other than the proper officials of the acquiring agency or officials of the U.S. Department of Housing and Urban Development and I will not do so until so authorized by said officials, or until I am required to do so by due process of law, or until I am released from this obligation by having publicly testified as to such findings.

That I have not given consideration to, or included in my appraisal, any allowance for relocation assistance benefits.

That my opinion of the fair market value of the property to be acquired as of the ____________ day of ___________________ 20 _______ is $______________________________ based upon my independent appraisal and the exercise of my professional judgment.

Name _________________________________ Signature _________________________________

Date _____________________________________

(Note: Other statements, required by the regulations of an appraisal organization of which the appraiser is a member or by circumstances connected with the appraisal assignment or the preparation of the appraisal, may be inserted where appropriate.)

App. 19-4 [03/07]

Appendix 005- Appraiser Certification


GUIDEFORM - VOLUNTARY ACQUISITION –

- Informational Notice -(Agencies Without Eminent Domain Authority)

Grantee or Agency Letterhead (date)

Dear ___________:

(Name of Agency/Person) ________________________, is interested in acquiring property you own at (address) ___________________________ for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD).

Please be advised that (Name of Agency/Person) ________________________ does not have authority to acquire your property by eminent domain. In the event we cannot reach an amicable agreement for the purchase of your property, we will not pursue this proposed acquisition.

We are prepared to offer you ($) ________________________________ to purchase your property. We believe this amount represents the current market value of your property. Please contact us at your convenience if you are interested in selling your property.

In accordance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA), owner-occupants who move as a result of a voluntary acquisition are not eligible for relocation assistance.

If you have any questions about this notice or the proposed project, please contact (name)______________________, (title)____________, (address)_________________________________, (phone)___________________.

Sincerely,

(name and title)__________________________

NOTES.

1. The case file must indicate the manner in which this notice was delivered (e.g.,certified mail, return receipt requested) and the date of delivery.

App. 31-1 [03/07]

Appendix 006- Notice to Owner - Voluntary Acquisition- No E/D


2. Tenant-occupants displaced as a result of a voluntary acquisition may be entitledto URA relocation assistance and must be so informed per 49 CFR 24.2(a)(15)(iv)– Initiations of negotiations, and 49 CFR 24 Appendix A - 24.2(a)(15)(iv).

3. This is a guideform. It should be revised to reflect the circumstances.

[03/07] App. 31-2


GUIDEFORM - VOLUNTARY ACQUISITION –

- Informational Notice -(Agencies With Eminent Domain Authority)

Grantee or Agency Letterhead

(date)

Dear _________________:

(City, County, State, other) ________________________, is interested in acquiring property you own at (address) ___________________________ for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________ program.

Please be advised that, (City, County, State, other) ________________________ possesses eminent domain authority to acquire property, however, in the event you are not interested in selling your property, or if we cannot reach an amicable agreement for the purchase of your property, we will not pursue its acquisition under eminent domain.Your property is not a necessary part of the proposed project and is not part of an intended, planned, or designated project area where substantially all of the property within the area is to be acquired.

We are prepared to offer you ($)_________________________ to purchase your property. We believe this amount represents the current market value of your property. Please contact us at your convenience if you are interested in selling your property.

In accordance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA), owner-occupants who move as a result of a voluntary acquisition are not eligible for relocation assistance.


Sincerely,

(name and title)__________________________

NOTES.

1. The case file must indicate the manner in which this notice was delivered (e.g.,certified mail, return receipt requested) and the date of delivery.

App. 32-1 [03/07]

Appendix 007- Notice to Owner- Voluntary Acquisition- with E/D


2. Tenant-occupants displaced as a result of a voluntary acquisition may be entitled toURA relocation assistance and must be so informed per 49 CFR 24.2(a)(15)(iv) –Initiations of negotiations, and 49 CFR 24 Appendix A - 24.2(a)(15)(iv).

3. This guideform may only be used if all of the requirements of 49 CFR24.101(b)(1)(i)-(iv) are met.


[03/07] App. 32-2

Appendix 008 - Voluntary Acquisition- Alternative Valuation


GUIDEFORM NOTICE TO OWNER - INVOLUNTARY ACQUISITION -

(Threat/Use Of Eminent Domain)


(date)

Dear ___________:

(City, County, State, Tribe, other) ________________________, is interested in acquiring property you own at (address) ___________________________ for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________ program.

The purpose of this notice is to inform you of your rights under a federal law known as the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA). Enclosed is a HUD brochure entitled “When A Public Agency Acquires Your Property”. This brochure provides useful information about the public acquisition of real property (real estate) under the URA. At this stage, your property is only under consideration for acquisition. This notice is not a contractual offer or commitment to purchase your property.

If your property is selected for acquisition, under the URA, you will have the right to receive just compensation for your property. In order to determine the amount of just compensation to be offered to you, an appraisal of your property would be required. In such a case, an appraiser will contact you to provide you an opportunity to accompany him or her on the inspection of your property. It would be in your best interest to accompany the appraiser during the property inspection so that you can point out any unique features of your property which should be considered in the valuation process and so that you can also answer any questions the appraiser may have.

For your information, (City, County, State, Tribe, other) ________________________ possesses eminent domain authority to acquire the property needed for this project, however, our goal is to attempt to negotiate amicable agreements for all property acquisitions prior to its use. If negotiations fail, acquisition under eminent domain may be considered.


Sincerely,

App. 30-1 [03/07]

Appendix 009- Notice of Intent


(name and title)__________________________

Enclosure

______________________________________________________________________________________ NOTES.

1. The case file must indicate the manner in which this notice was delivered (e.g., certified mail, returnreceipt requested) and the date of delivery.


2. A notice to owner is merely an Agency’s notice informing the owner of the agency’s interest inacquiring the property; it is not a commitment and does not establish relocation eligibility. Whereas anotice of intent to acquire is an Agency’s written notice provided to a person to be displaced; it is acommitment and clearly establishes relocation eligibility in advance of the normal acquisition andrelocation process. A notice to owner is required under 49 CFR 24.102(b) for acquisitions subject to 49CFR part 24, subpart B.

App. 30-2 [03/07]

Appendix 010 - Notice of Just Compensation (Offer to Purchase)

SUMMARY STATEMENT BASIS FOR THE DETERMINATION OF VALUE

Description and Location of Property:

The Property to be acquired is located at , and is also described as that lot or parcel in the City of , County of

, state of , and identified as: (Lot Number, Subdivision, Plat, etc,) , also recorded in (Book, Page, and

Date) in the records located at .

This is the same property described in a deed from to , dated , 20 , and recorded in Deed Book

, Page , Clerk's Office, ,and on record at Tax Map: Map Code: , Route #: .

Purpose of Purchase:

Interest in the Property:

Improvements:

Declaration of Offer: Based on the appraisal and the review appraisal prepared for the property to be acquired, the State/County/City of hereby makes you an offer to acquire your property in the amount of

dollars ($ .00), This offer is for the fair market value of your property and does not include any consideration of decrease or increase in value attributable to the project in which it is being acquired. If relocation payments are applicable, they are not represented in the amount identified in this offer letter.

Should you have any questions concerning this summary statement and the State/County/City offer, please contact (Name) at the (Subrecipient or other funded entity name) , phone number .

Signature of Authorizing Official Date

A. Settlement Statement (HUD-1)

HUD-1Page 1 of 3Previous edition are obsolete

B. Type of Loan

J. Summary of Borrower’s Transaction

100. Gross Amount Due from Borrower

C. Note:

400. Gross Amount Due to Seller

This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked “(p.o.c.)” were paid outside the closing; they are shown here for informational purposes and are not included in the totals.

401. Contract sales price

106. City/town taxes to

to

to

to

to

to

to

to

to

to

to

to

406. City/town taxes

203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to

212. Assessments 512. Assessments

302. Less amounts paid by/for borrower (line 220) 602. Less reductions in amounts due seller (line 520)( ) ( )

213. 513.

214. 514. 215. 515. 216. 516.

218. 518.

217. 517.

219. 519.

102. Personal property

101. Contract sales price

402. Personal property

107. County taxes 407. County taxes

204. 504. Payoff of first mortgage loan

103. Settlement charges to borrower (line 1400) 403.

108. Assessments 408. Assessments

205. 505. Payoff of second mortgage loan

104. 404.

109. 409.

206. 506.

201. Deposit or earnest money 501. Excess deposit (see instructions)

210. City/town taxes 510. City/town taxes

105.

1.

D. Name & Address of Borrower:

G. Property Location:

E. Name & Address of Seller: F. Name & Address of Lender:

I. Settlement Date:H. Settlement Agent:

Place of Settlement:

2. 3.FHA RHS Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:

VA Conv. Ins.4. 5.

405.

110. 410.

207. 507.

202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400)

211. County taxes 511. County taxes

301. Gross amount due from borrower (line 120) 601. Gross amount due to seller (line 420)

111. 411.

208. 508.

112. 412.

209. 509.

120. Gross Amount Due from Borrower 420. Gross Amount Due to Seller200. Amount Paid by or in Behalf of Borrower 500. Reductions In Amount Due to seller

Adjustments for items unpaid by seller Adjustments for items unpaid by seller

220. Total Paid by/for Borrower 520. Total Reduction Amount Due Seller

303. Cash 603. CashFrom ToTo Borrower From Seller

300. Cash at Settlement from/to Borrower 600. Cash at Settlement to/from Seller

Adjustment for items paid by seller in advance Adjustment for items paid by seller in advance

K. Summary of Seller’s Transaction

OMB Approval No. 2502-0265

The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process.

Appendix 011 - HUD 1 Settlement Statement


L. Settlement Charges

700. Total Real Estate Broker Fees

800. Items Payable in Connection with Loan

900. Items Required by Lender to be Paid in Advance

1000. Reserves Deposited with Lender

1100. Title Charges

1200. Government Recording and Transfer Charges

1300. Additional Settlement Charges

702. $ to

to

802. Your credit or charge (points) for the specific interest rate chosen

902. Mortgage insurance premium for months to

1002. Homeowner’s insurance months @ $ per month $

1102. Settlement or closing fee

1202. Deed $ Mortgage $ Release $

1302.

701. $

801. Our origination charge

901. Daily interest charges from to @ $ /day

1001. Initial deposit for your escrow account

1101. Title services and lender’s title insurance

1201. Government recording charges

1301. Required services that you can shop for

703. Commission paid at settlement

Division of commission (line 700) as follows :

803. Your adjusted origination charges

903. Homeowner’s insurance for years to

1003. Mortgage insurance months @ $ per month $

1103. Owner’s title insurance

1203. Transfer taxes

1303.

704.

804. Appraisal fee to

904.

1004. Property Taxes months @ $ per month $

1104. Lender’s title insurance

1204. City/County tax/stamps Deed $ Mortgage $

1304.

1005. months @ $ per month $

1105. Lender’s title policy limit $

1205. State tax/stamps Deed $ Mortgage $

1305.

1006. months @ $ per month $

1106. Owner’s title policy limit $

1206.

1007. Aggregate Adjustment -$

1107. Agent’s portion of the total title insurance premium to

1108. Underwriter’s portion of the total title insurance premium to

1109.

1110.

1111.

805. Credit report to

806. Tax service to

807. Flood certification to

808.

809.

810.

811.

Paid FromBorrower’sFunds at

Settlement

Paid FromSeller’s

Funds atSettlement

$

$

$

$

$

$

1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K)

(from GFE #1)

(from GFE #3)

(from GFE #2)

(from GFE #3)

(from GFE #10)

(from GFE #4)

(from GFE #3)

(from GFE #11)

(from GFE #9)

(from GFE #5)

(from GFE #7)

(from GFE #8)

(from GFE #6)

(from GFE #A)

(from GFE #3)

(from GFE #3)

$

$


Comparison of Good Faith Estimate (GFE) and HUD-1 Charrges

% $ or

Charges That In Total Cannot Increase More Than 10%

Good Faith Estimate

Good Faith Estimate

Good Faith Estimate

Total

Increase between GFE and HUD-1 Charges

HUD-1

HUD-1

HUD-1

Charges That Cannot Increase HUD-1 Line Number

Government recording charges

Charges That Can Change

Your initial loan amount is

Loan Terms

Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.

Daily interest charges

Your initial interest rate is

Initial deposit for your escrow account

Your loan term is years

No

No

No

No

Property taxes Homeowner’s insurance

Flood insurance

No

Yes, it can rise to a maximum of %. The first change will be on

Yes, the first increase can be on and the monthly amount

Yes, it can rise to a maximum of $

Yes, your maximum prepayment penalty is $

Yes, you have a balloon payment of $ due in yearson .

You do not have a monthly escrow payment for items, such as property taxes and

You have an additional monthly escrow payment of $

that results in a total initial monthly amount owed of $ . This includes

principal, interest, any mortagage insurance and any items checked below:

homeowner’s insurance. You must pay these items directly yourself.

Principal

Interest

Mortgage Insurance

includes

%

Our origination charge

Your credit or charge (points) for the specific interest rate chosen

Your adjusted origination charges

Transfer taxes

Homeowner’s insurance

Your initial monthly amount owed for principal, interest, and any

mortgage insurance is

Can your interest rate rise?

Even if you make payments on time, can your loan balance rise?

Does your loan have a prepayment penalty?

Does your loan have a balloon payment?

Total monthly amount owed including escrow account payments

Even if you make payments on time, can your monthly

amount owed for principal, interest, and mortgage insurance rise?

$

# 1001

#

# 1201

# 901

#

# 903

#

# 801

#

#

# 802

#

#

# 803

#

#

#

# 1203

$ /day

$

and can change again every after . Every change date, your

interest rate can increase or decrease by %. Over the life of the loan, your interest rate is

guaranteed to never be lower than % or higher than %.

owed can rise to $ . The maximum it can ever rise to is $ .

Appendix 012 - Sample Title Report

Appendix 013 - Administrative Settlement

Justification for exceeding original estimate of market value, including trial risks. Please include brief listing of supporting documentation available.

Check the following boxes that apply:

☐ Acknowledgement of compliance with HUD program regulations and/or policies in negotiatingagreements for a property which exceeds the agency’s market value determination.

☐ Acknowledge compliance with the applicable OMB Circulars, specifically, OMB Circular A-87 “CostPrinciples for State, Local and Indian Tribal Governments, “ in particular, provides that costs must “[b]enecessary and reasonable for proper and efficient performance and administration of Federal awards.”

☐ Acknowledgement that this administrative settlement process should be maintained separate fromthe appraisal/appraisal review function. If support for a settlement is based on appraisal-related issues,a revised fair market value/just compensation determination will be made.

☐ Acknowledgement that the requirements of 49 CFR 24.102(i) are intended to ensure that an acquiringagency explains the reasoning behind its decision to incur trial costs, which then serves asdocumentation for participation in the cost above the initial offer.

☐ The understanding that relocation payments are not an acquisition cost and cannot be used tosupport an administrative settlement in whole or in part.

☐ Acknowledgement of compliance with 49 CFR Section 24.102(c)(2)(ii) which provides for theacquisition of parcels without an appraisal when the estimated just compensation for the parcel is$10,000 or less.

1

Appendix 014 - Condemnation Court Record/Case File

Property Address

Block

Lot

Property Description

Attestation that the Eminent Domain Act of 1971, N.J.S.A. 20:3-1 et seq. prescribed four-step process has occurred:

☐ 1) An attempt to resolve the acquisition outside of litigation through bona fide negotiations betweenthe condemnor and the property owner;☐ 2) in lieu thereof, final disposition by judgment of the authority and due exercise of the power ofeminent domain by the condemnor;☐ 3) Non-binding arbitration of the issue of just compensation by commissioners appointed by thecourt;☐ 4) Trial of the issue of just compensation.

Appraisal Date

Appraisal Determination

Was a copy of appraisal provided to the property

owner?

☐ Yes ☐ No

Complaint Filing Date

Agent Verifying Complaint

Defendant

Lis Pendens Filing Date

Date Defendant was served

Method of Serving Defendant ☐ In person ☐ Newspaper publicationDefendant Answer Date (if

applicable)

1

Does the condemnor have the right to possess the property?

☐ Yes ☐ No

Commissioners Hearing Date Commissioners Hearing Result

Appeal Filing Date Appeal Extension Date (if

applicable)

Appeal Determination

Compensation Offered $ Method to Determine Time of

Valuation ☐ a) the date possession of the property being condemned is taken by the condemnor in whole or in part; ☐ b) the date of the commencement of the action; ☐ c) the date on which action is taken by the condemnor which substantially affects the use and enjoyment of the property by the condemnee; ☐ d) the date of a declaration of blight

Is Interest Owed? ☐ Yes ☐ No Interest Collection Start Date

Is this case a partial taking? ☐ Yes ☐ No If yes, what method was used

to determine damages? ☐ The difference in the property’s value before and after the taking ☐ The value of land taken plus the diminution of value to the remainder land

2

of 3 4/12/2017

S ite Occupant Record - Residential Project Name: Project #: Relocation Case #: Acquisition Parcel #:

LOCALITY/AGENCY

Date of Initial Interview: Interviewer:

NAME OF OCCUPANT ADDRESS TELEPHONE NUMBER CENSUS TRACT

CHECK: FAMILY INDIVIDUAL OWNER TENANT

DATE OF GENERAL INFORMATION NOTICE

IS THIS ADDRESS LOCATED IN A HUD DESIGNATED RENEWAL COMMUNITY OR EMPOWERMENT ZONE? YES NO

DATE OCCUPANT FIRST OCCUPIED THIS DWELLING

EFFECTIVE DATE OF NOTICE OF ELIGIBILITY FOR RELOCATION ASSISTANCE DATE PRIVACY ACT STATEMENT EXECUTED (INCLUDE COPY OF NOTICES AND SIGNED PRIVACY ACT STATEMENT IN CASE FILE)

RACIAL CLASSIFICATION HOUSING COSTS AND CHARACTERISTICS OF DISPLACEMENT DWELLING

(CHECK ALL THAT APPLY) AMERICAN INDIAN OR ALASKAN NATIVE ASIAN BLACK OR AFRICAN AMERICAN HISPANIC OR LATINO NATIVE HAWAIIAN OR OTHER PACIFIC

ISLANDER WHITE

TENANT: MONTHLY CONTRACT RENT $ AVERAGE MONTHLY UTILITY COSTS $ MONTHLY HOUSING COSTS $

OWNER: MONTHLY MORTGAGE PAYMENT (P&I) AVERAGE MONTHLY UTILITY COSTS REAL PROPERTY TAXES MONTHLY HOUSING COSTS

$

$ $ $

AMERICAN INDIAN OR ALASKAN NATIVE AND WHITE

NO. OF ROOMS NO. OF BEDROOMS UNIT IS: HOUSEKEEPING NONHOUSEKEEPING

ASIAN AND WHITE BLACK OR AFRICAN AMERICAN AND WHITE AMERICAN INDIAN OR ALASKAN NATIVE AND BLACK OR AFRICAN AMERICAN

OTHER MULTI-RACIAL

ETHNICITY CLASSIFICATION

HISPANIC OR LATINO

NOT HISPANIC OR LATINO

Appendix 015 - Site Occupancy Record- Residential

of 3 4/12/2017

SURNAME, GIVEN NAME(S)/SSN(S)

RELA- TION- SHIP

SEX AGE OCCUPATION

SOURCE OF INCOME GROSS

MONTHLY INCOME

NAME OF EMPLOYER AND TELEPHONE NUMBER EMP. WELF. PENS. OTHER

(IDENTIFY)

$

TOTAL GROSS MONTHLY INCOME: $

SPECIAL CHARACTERISTICS OF HOUSEHOLD (E.G., DISABLED, ELDERLY, ETC.)

REHOUSING PREFERENCES: PURCHASE RENT SUBSIDIZED HOUSING NONE

LOCATION/NEIGHBORHOOD CONSIDERATIONS:

PETS, GARAGE, ETC.:

REHOUSING REQUIREMENTS: NO. OF ROOMS NO. OF BEDROOMS MAX. MONTHLY HOUSING COSTS $ MAX. PURCHASE

PRICE $

of 3 4/12/2017

HOUSING REFERRALS

Date Address (Include Apt No.)

Census Track

Type of Unit Size of Unit

Monthly Rent + Est. Avg. Monthly Utility

or Costs/Sales

Price Unit Inspd

Unit Avail Date

Low Income Or Minority Area?

Action on Referral (If refused, indicate why. Also indicate whether unit is representative comparable used as basisfor pmt limit.)

Rent Sales Subsidized # of Rms

# of Bdrms

REPLACEMENT DWELLING UNIT

DATE OF MOVE ADDRESS CENSUS TRACT IS THIS ADDRESS LOCATED IN A HUD DESIGNATED RENEWAL COMMUNITY OR EMPOWERMENT ZONE? YES NO

MONTHLY HOUSING COST (MHC) RENTAL PURCHASE

MONTHLY RENT $ MORTGAGE PAYMENT (P&I) $ EST. AVERAGE REAL ESTATE TAXES $ MONTHLY EST. UTILITY COSTS $ UTILITY COSTS $ TOTAL MHC $ TOTAL MHC $ SALES PRICE $

D. S. & S NOT D. S. & S DATE OF INSPECTION DATE OF REINSPECTION NO. OF ROOMS NO. OF BEDROOMS (Include copy of Inspection Report in case file.)

RELOCATION PAYMENT(S) MOV.EXP. RHP

TYPE ACTUAL RENTAL FIXED DOWNPMT

180-DAYHO

AMOUNT $ $ DATE CLAIM FILED DATE CLAIM PAID (Include copy of Claim Forms in Case File)

IS UNIT IN AREA OF LOW-INCOME OR MINORITY CONCENTRATION?

YES NO IS UNIT SUBSIDIZED?

YES NO

(Identify)

TEMPORARY HOUSING DATE REASON

ADDRESS RENTAL $ DATE OF MOVE TO PERMANENT DWELLING OUT-OF-POCKET EXPENSES PAID:

MOVING EXPENSES $ INCREASED HOUSING COSTS $

APPEAL FILED: YES NO IF YES, INDICATE TYPE:

PAYMENT(S) HOUSING OTHER

(Include copy of Appeal in Case File)

of 2 Handbook 1378-Chg 6 Appendix 9

10/06

Site Occupant Record - Nonresidential Project Name: ____________________ Project #: ________________________ Relocation Case #: ________________ Acquisition Parcel #: ______________

LOCALITY/AGENCY

Date of Initial Interview: _________________ Interviewer: ________________________________________

NAME UNDER WHICH BUSINESS TRADES/OPERATES:

_______________________________________________________________ ADDRESS __________________________________________________________

_______________________________________________________________ TELEPHONE NUMBER _________________

NAME OF PRINCIPAL OFFICER: ___________________________ HOME ADDRESS: _______________________________________ TELEPHONE #: _________________________________________

DATE OF GENERAL INFORMATION NOTICE ___________ EFFECTIVE DATE OF NOTICE OF ELIGIBILITY FOR RELOCATION ASSISTANCE ______________ DATE PRIVACY ACT STATEMENT EXECUTED ______________ (INCLUDE COPY OF NOTICES AND SIGNED PRIVACY ACT STATEMENT IN CASE FILE)

IS THIS ADDRESS LOCATED IN A HUD DESIGNATED RENEWAL COMMUNITY OR EMPOWERMENT ZONE? YES NO

DATE OCCUPANT FIRST OCCUPIED THIS LOCATION ______________

OCCUPANT CHARACTERISTICS

YEARS IN BUSINESS _________ YEARS AT THIS LOCATION _________

TENURE: OWNER TENANT OPERATION: BUSINESS

NONPROFIT ORGAN. FARM

TYPE OF OWNERSHIP SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION NONPROFIT ORGANIZATION

RACIAL/ETHNIC CLASSIFICATION (CHECK ALL THAT APPLY)

AMERICAN INDIAN OR ALASKAN NATIVE ASIAN BLACK OR AFRICAN AMERICAN HISPANIC OR LATINO NATIVE HAWAIIAN OR OTHER PACIFIC

ISLANDER WHITE AMERICAN INDIAN OR ALASKAN NATIVE AND

WHITE ASIAN AND WHITE BLACK OR AFRICAN AMERICAN AND WHITE AMERICAN INDIAN OR ALASKAN NATIVE AND

BLACK OR AFRICAN AMERICAN OTHER MULTI-RACIAL

CHARACTER OF BUSINESS OPERATION

____________________________________ ____________________________________ ____________________________________ (e.g., manufacturing, wholesale trade, retail trade, business service, personal service, institutional) RELOCATION PREFERENCES AND REQUIREMENTS

RELO PREFERENCES: WILL MAKE OWN PLANS NONE RENT PURCHASE BUILD LOCATION CONSIDERATIONS __________________________________________________________ _____________________________________________________________________________________ SPACE NEEDS ________________________________________________________________________ OTHER SPECIAL NEEDS ________________________________________________________________ TYPE/SIZE OF BUILDING ________________________________________________________________ MAXIMUM MONTHLY RENTAL $ ___________ MAXIMUM SALES PRICE $ _______________________ BUSINESS WILL DISCONTINUE OPERATIONS (EXPLAIN) _____________________________________

SPACE OCCUPIED (At displacement property)

____________________________________ SERVICES PROVIDED (if tenant)

____________________________________ ____________________________________ ____________________________________ MONTHLY RENTAL $ _________________

Appendix 016 - Site Occupancy Record- Non-Residential

of 2 Handbook 1378-Chg 6 Appendix 9

10/06

REFERRALS TO REPLACEMENT LOCATIONS

DATE ADDRESS RENTAL SALES RENTAL OR

SALES PRICE DESCRIPTION OF REFERRAL

ACTION ON REFERRAL

(If refused, indicate reason)

REPLACEMENT LOCATION

DATE AGENCY NOTIFIED OF INTENTION TO MOVE __________

DATE AGENCY INSPECTED PREMISES ____________ ADDRESS TO WHICH MOVED: ___________________________________ _____________________________________________________________ CENSUS TRACT __________ TELEPHONE ________________________

DATE MOVE BEGAN __________ DATE MOVE COMPLETED _________

TENURE AT REPLACEMENT LOCATION:

OWNED SALES PRICE $ __________________

RENTED MONTHLY RENTAL $ __________________ DESCRIPTION OF REPLACEMENT LOCATION: ______________________

____________________________________________________________________

REPLACEMENT PAYMENT

DATE DATE

CLAIM CLAIM

AMOUNT FILED PAID

ACTUAL MOVING EXPENSES $ _______ ________ ________ REESTABLISHMENT EXPENSES $ _______ ________ ________ FIXED PAYMENT $ _______ ________ ________

(Include copy of claim form and related documentation in case file)

TEMPORARY MOVE

REASON_______________________________

_______________________________________

DATE __________ ADDRESS ____________

_______________________________________

DATE OF MOVE FROM TEMORARY LOCATION TO

PERMANENT LOCATION __________

APPEAL FILED: YES NO (If yes, include copy in case file)

REMARKS:

Appendix 017 - Site Record Photographs

Exterior Photos

Interior Photos

Appendix 018 - Occupant Photo Identification

Valid Driver’s License

Valid Passport

Valid Permanent Resident Card

1

Name: Current Address:

Unit #:

Telephone No:

Number of Bedrooms:

Number of Rooms: Current rent: $ /month Utilities: $ /month

Rental Assistance: Housing Grants: Yes☐ No☐ Section 8: Yes☐ No☐ Other: Yes☐_____________No☐

Month to month lease Yes☐ No☐ Long term Lease Yes☐ No☐ Expiration Date:

1. Complete the chart below with the name, date of birth, sex, and relationship to Head of Household (HOH) for each

person who occupies this unit.

Name Date of

Birth

Age Sex Relationship

to Head of

Household

Fulltime

Student

(18+)

Disabled Child (17

or below)

Elderly

(62 +)

HOH ☐ ☐ ☐ ☐

2 ☐ ☐ ☐ ☐

3 ☐ ☐ ☐ ☐

4 ☐ ☐ ☐ ☐

2. Does anyone in the household receive any of the following income types?

a. Earn income from a job (fulltime, part-time, seasonal,

temporary, self-employed, or commission)?

Yes☐ No☐

b. Unemployment Benefits? Yes☐ No☐

c. Disability/Worker’s Compensation? Yes☐ No☐

d. Social Security or SSI Disability? Yes☐ No☐

e. Pension/Retirement? Yes☐ No☐

f. TANF? Yes☐ No☐

g. Alimony/Child Support? Yes☐ No☐

h. Foster Care/Adoption Assistance? Yes☐ No☐

i. Cash assistance from family/friends? Yes☐ No☐

j. Scholarships? Yes☐ No☐

j. Veteran Administration Benefit? Yes☐ No☐

k. Other income? Yes☐____________________No☐

For each ‘Yes’ selected above, list the income amount received by each household member:

Household Member

Name

Income Type Employer/Income

Source Name

Amount Frequency Received

Appendix 019 - Resident/Occupant Interview Form

DATE OF INTERVIEW:

2

3. If the HOH, co-head, or spouse is disabled or at least 62+, are there any of the following Medical Expenses not

covered by insurance: Yes☐ No☐ N/A☐

If ‘Yes’, complete the following information:

Medical Expense Amount Frequency Annual Total

Prescriptions Yes☐ No☐

Doctor bills/co-pays Yes☐ No☐

Insurance premiums Yes☐ No☐

Hospital bills Yes☐ No☐

Other expense Yes☐ ___________No☐

4. If at least one household member is disabled, are there any Disability Expenses for the care of the disabled person that

enable a household member to work and are not covered by insurance? Yes☐ No☐ N/A☐


Disability Expense Amount Frequency Who is enabled to

work?

Care attendant Yes☐ No☐

Service animal Yes☐ No☐

Other expense Yes☐ ___________No☐

5. If there is a child 12 years or younger in the household, are there Childcare Expenses that allow an adult member of

the household to go to work, school, or to search for a job? Yes☐ No☐ N/A☐


Name of Child Who is enabled to go

to school/work/search

for a job?

Name of Activity

(work, school, job

searching)

Provider Name,

address, and phone

number

Childcare

Cost

Payment

Frequency

6. Does anyone in the household possess any of the following assets?

a. Retirement Account (401k, IRA, 403B, mutual funds,

etc.)? Yes☐ No☐

b. Certificate of Deposit (CD)? Yes☐ No☐

c. Money Market Funds? Yes☐ No☐

d. Whole Life Insurance Policy? Yes☐ No☐

e. Real Estate? Yes☐ No☐

f. Stocks or Bonds? Yes☐ No☐

g. Checking Account? Yes☐ No☐

h. Savings Account? Yes☐ No☐

i. Other assets? Yes☐____________________No☐

For each ‘Yes’ selected above, list the income amount received by each household member:

Household Member

Name

Asset Type Financial Institution

Name (if applicable)

Cash Value of Asset Interest Rate

3

7. Did any household member give away or sell an asset for less than fair value within the last two years? Yes☐ No☐

If yes, please explain the value of the asset and how much it was sold for:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

TOTAL ANNUAL GROSS INCOME: $__________________

TOTAL ADJUSTED INCOME: $__________________

AREA MEDIAN INCOME (%)___________________

8. What is the racial group and ethnicity for each household member? We need to know this for statistical purposes.

Name Race Ethnicity

(Hispanic or

Latino)

HOH Yes☐ No☐

2

Yes☐ No☐

3

Yes☐ No☐

4

Yes☐ No☐

Race

American Indian/Alaskan Native

American Indian/Alaskan Native & Black/African

American

American Indian/Alaskan Native & White

Asian

Asian & White

Black/African American

Black/African American & White

Native Hawaiian/Other Pacific Islander

Other multi-racial

Unknown

White

9. What language do you speak in your home? ______________________

10. Do you or someone in your household speak/read English? Yes☐ No☐

11. Is there any information that you can provide that will enable us to better serve your housing needs?

(disability, i.e. mobility, visual or hearing impairment)

_______________________________________________________________________

4

_______________________________________________________________________

_______________________________________________________________________

________________________________________________________________________

12. Do you have any pets in the household? Yes☐ No☐

If Yes, describe___________________________________________________________

13. Do you own a car? Yes☐ No☐

14. Do you use public transportation regularly? Yes☐ No☐ Type_____________________

15. What is your rehousing preference?

☐Purchase another manufactured mobile home

☐Purchase a house

☐Rent an apartment

☐Other ____________________

16. If you were to move, do you have any preference where?_________________________

______________________________________________________________________

______________________________________________________________________

17. Are there any issues or concerns that you would like to add regarding your current housing situation?

_____________________________________________________________________

_____________________________________________________________________

18. We may need to contact you again to ask additional questions:

Home Phone: _________________ Work Phone: _________________

Email Address:_______________________________________

APPLICANT CERTIFICATION I certify that the information provided in this questionnaire is true and accurate to the best of my/our ability. I

understand that if this information is not correct, it may affect the amount of any grant I may receive.

Name (Typed or Printed) Resident Signature Date

Name (Typed or Printed) Resident Signature Date

WARNING: The information provided on this form is subject to verification by the State of New Jersey and the

Department of Housing and Urban Development (HUD) at any time. Title 18, Section 1001 of the U.S. Code

states that knowingly and willingly making a false or fraudulent statement to a department of the United States

Government can result in termination of assistance and civil and criminal penalties.

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_______________________________________________________________________________

SURVEYORS USE ONLY:

Name: ___________________________________________ Date Surveyed: ______________

Overcrowded: Yes ____ No ____ Obvious Health & Safety Conditions: Yes ____ No ____

Comments _________________________ __________________________ _____________

_________________________ _______________________ ______________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Attempts: Date Time Comment

1st __________ __________ _______________________

2nd __________ __________ _______________________

3rd __________ __________ _______________________

Call: _________________________________

Reschedule: _________________________________

Signature of Head of Household Printed Name Date

INCOME CE RTIF IC AT ION APPLICANT NAME: UNIT NO: DAMAGED RESIDENCE ADDRESS: HOUSEHOLD MEMBERS: List all household members and provide the requested information. “Household” is defined as all persons living in the same dwelling unit, regardless of relationship.

The number of people presently in my household who are 18 years of age or older: The number of people presently in my household who are younger than 18 years of age: Total household members: List the ANNUAL INCOME of all adult household members for 2017. “Adult” is defined as any household member 18 years or older.

Household Member Name Income Source #1 Income Source #2 Income Source #3 TOTAL

Type (such as name of employer, SS/SSDI, Retirement, Unemployment

Amount Type Amount Type Amount Amount

TOTAL

ESTIMATE TOTAL ANNUAL HOUSEHOLD INCOME FOR 2017:

When developing this estimate only include amounts that are certain to be received in 2017. For example, if it is uncertain whether your salary will increase in 2017 or if your interest income or tips/bonus amounts are unknown, please use the 2016 amount when estimating 2017 income.

HEAD OF HOUSEHOLD MUST SIGN: I certify that this information regarding my 2016 and 2017 household income is complete and accurate. I agree to provide additional information and documentation on all income sources upon request.

WARNING: The information provided on this form is subject to verification by the State of New Jersy and the Department of Housing and Urban Development (HUD) at any time. Title 18, Section 1001 of the U.S. Code states that knowingly and willingly making a false or fraudulent statement to a department of the United States Government can result in termination of assistance and civil and criminal penalties.

2017

Appendix 020 - Income Certification

Appendix 021 - Sample Lease/Occupancy Agreement Residential

Lease Agreement

1. Parties and Dwelling Unit

Property Address: _____________________________________________________________________________________ Street Address City State Zip Code

Unit Number: __________

Landlord Name: Tenant Name:

Lease Effective Date: Number of Bedrooms: Initial Rent: Utilities Provided by Landlord: Electricity Heating Water Sewer Trash

Utilities Paid for by Tenant: Electricity Heating Water Sewer Trash

Appliances Provided by Landlord: Stove Refrigerator

2. Term of the LeaseThe term of this Agreement is for a period of at least one year, and shall begin on_________________________________ and end on _________________________.

3. RentThe Tenant agrees to pay $____________ for the partial month ending on ______________. After that,the Tenant agrees to pay a rent of $_________ per month. This amount is due on the 5th day of the month at the below address:____________________________________________________________________________________________________________________________________.

The Landlord may not raise the rent during the initial term of the lease and the unit rent may not exceed this amount. The Landlord may not charge the Tenant extra amounts for items customarily not included in rent in the locality in which the Premises are located. The Landlord certifies that any Security Deposit or other charge in addition to rent is consistent with State of New Jersey Landlord Tenant Laws and Regulations.

4. Charges for Late Payments and Returned ChecksIf the Tenant does not pay the full amount of the rent shown in paragraph 3 by the end of the 5th day ofthe month, the Landlord may collect a fee of $5 on the 6th day of the month. Thereafter, the Landlordmay collect $1 for each additional day the rent remains unpaid during the month it is due.

The Landlord may not terminate this Agreement for failure to pay late charges, but may terminate this Agreement for non-payment of rent. The Landlord may collect a fee of $________ on the second, or any additional time a check is not honored for payment (bounces). The charges discussed in this paragraph are in addition to the regular monthly rent payable by the Tenant.

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5. Condition of the Dwelling Unit By signing this Agreement, the Tenant acknowledges that the unit is decent, safe, and sanitary. The Tenant agrees that all appliances and equipment in the unit are in good working order, as described on the Unit Inspection Report, if applicable. The Tenant also agrees that the Landlord has made no promises to decorate, alter, repair or improve the unit, except as listed on the Unit Inspection Report. 6. Security Deposits Upon the execution of this Agreement, the Tenant shall deposit with the Landlord the sum of _________________________________________________________ DOLLARS ($______________) receipt of which is hereby acknowledged by the Landlord, as security for any damage caused to the Property during the term hereof. In accordance with New Jersey law (NJSA Section 46:8-19), the Landlord will pay the Tenant interest on the Tenant's Security Deposit, less any service fee charged by the bank or investment company. Interest will be paid annually on the anniversary of Tenant's Lease in cash or as a credit towards rent due. Further, the Landlord will annually notify the Tenant of certain information concerning the Security Deposit: the name of the bank where the Security Deposit is held, the type of account in which the funds are deposited, and the account's interest rate. The Security Deposit may not be used to pay rent or other charges while the Tenant occupies the dwelling unit. No refund of the Security Deposit will be made until the Tenant has vacated, and the dwelling unit has been inspected by the Landlord. After the Tenant has moved from the unit, the Landlord will inspect the unit and complete another Unit Inspection Report. The Landlord will permit the Tenant to participate in the inspection, if the Tenant so requests. The return of a Security Deposit shall occur within 30 days after Tenant moves out and has given notice of his/her new address to the Landlord. The Landlord will refund to the Tenant the amount of the Security Deposit plus interest due, less any amount needed to pay the cost of: (1) unpaid rent; (2) damages that are not due to normal wear and tear and are not listed on the initial Unit Inspection Report; (3) charges for late payment of rent and returned checks, as described in paragraph 5; and (4) charges for unreturned keys, as described in paragraph 7. The Landlord shall also give the Tenant a written list of charges that were subtracted from the deposit. If the Tenant disagrees with the Landlord about the amounts deducted and asks to meet with the Landlord, the Landlord agrees to meet with the Tenant and informally discuss the disputed charges. If the unit is rented by more than one person, the Tenants agree that they will work out the details of dividing any refund among themselves. The Landlord may pay the refund to any Tenant identified in paragraph 1 of this Agreement. If the Tenant is required to move to a unit of different size pursuant to paragraph 13, the Landlord agrees that the Security Deposit shall be applied towards the Security Deposit for the new unit. 7. Keys and Locks The Tenant agrees not to install additional or different locks or gates on any doors or windows of the unit without the written permission of the Landlord. If the Landlord approves the Tenant's request to install such locks, the Tenant agrees to provide the Landlord with a key for each lock. When this Agreement ends,

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the Tenant agrees to return all keys to the dwelling unit to the Landlord. The Landlord may charge the Tenant $ ___________ for each key not returned. 8. Maintenance

a. The Landlord agrees to (1) regularly clean all common areas of the property; (2) maintain the common areas and facilities in a safe condition; (3) arrange for collection and removal of trash and garbage; (4) maintain all equipment and appliances in safe and working order; (5) make necessary repairs with reasonable promptness; (6) maintain exterior lighting in good working order; (7) provide extermination services, as necessary; and (8) maintain grounds and shrubs.

b. The Tenant agrees to (1) keep the unit clean, use all appliances, fixtures, and equipment in a safe manner and only for the purposes for which they are intended; (2) not litter the grounds or common areas of the property; (3) not destroy, deface, damage, or remove any part of the unit, common areas, or property grounds; (4) give the Landlord prompt notice of any defects in the plumbing, fixtures, appliances, heating, and cooling equipment or any other part of the unit or related facilities; and (5) remove garbage and other waste from the unit in a clean and safe manner.

9. Damages Whenever damage is caused by carelessness, misuse, or neglect on the part of the Tenant, his/her family or visitors, the Tenant agrees to pay:

a. The cost of all repairs and do so within thirty (30) calendar days after receipt of the Landlord's demand for the repair charges; and

b. Rent for the period the unit is damaged whether or not the unit is habitable. 10. Restrictions on Alterations No alteration, addition, or improvements shall be made in or to the property without the prior consent of the Landlord in writing. The Landlord agrees to provide reasonable accommodation to an otherwise eligible Tenant’s disability, including making changes to rules, policies, or procedures, and making and paying for structural alterations to a unit or common areas. In addition, if a requested structural modification does pose a substantial financial and administrative hardship, the Landlord must then allow the Tenant to make and pay for the modification in accordance with the Fair Housing Act. 11. General Restrictions The Tenant must live in the unit and the unit must be the Tenant's only place of residence. The Tenant shall use the property only as a private dwelling for himself/herself and the individuals listed on the Certification and Recertification of Tenant Eligibility. The Tenant agrees to permit other individuals to reside in the unit only after obtaining the prior written approval of the Landlord. The Tenant agrees not to:

a. Sublet or assign the unit, or any part of the unit; b. Use the unit for unlawful purposes; c. Engage in or permit unlawful activities in the unit, in the common areas, or on the property

grounds; d. Have pets or animals of any kind in the unit without the prior written permission of the Landlord,

but the Landlord will allow the Tenant to keep an animal needed as a reasonable accommodation to the Tenant’s disability, and will allow animals to accompany visitors with disabilities who need such animals as an accommodation to their disabilities; or

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e. Make or permit noises or acts that will disturb the rights or comfort of neighbors. The Tenant

agrees to keep the volume of any radio, phonograph, television, or musical instrument at a level which will not disturb the neighbors.

12. Rules The Tenant agrees to obey the House Rules contained in the attachment to this Agreement, as applicable. The Tenant agrees to obey additional rules established after the effective date of this Agreement if:

a. The rules are reasonably related to the safety, care, and cleanliness of the building and the safety, comfort and convenience of the Tenants; and

b. The Tenant receives written notice of the proposed rule at least thirty (30) days before the rule is enforced.

13. Access by Landlord The Landlord agrees to enter the unit for the reasons set forth below only after providing reasonable advance notice of his/her intent to enter the unit and having received the Tenant's consent to do so during reasonable hours; except when an emergency situation exists that make such notice impossible.

a. The Tenant agrees to permit the Landlord, his/her agents or other persons, when authorized by the Landlord, to enter the unit for the purpose of making reasonable repairs and periodic inspections.

b. After the Tenant has given a notice of intent to move, the Tenant agrees to permit the Landlord to show the unit to prospective Tenants during reasonable hours.

c. If the Tenant moves before this Agreement ends, the Landlord may enter the unit to decorate, remodel, alter, or otherwise prepare the unit for re-occupancy.

14. Discrimination Prohibited Federal law prohibits Landlords from discriminating on the basis of race, color, religion, creed, National origin, sex, age, familial status, and disability. New Jersey Fair Housing laws further prohibit discrimination based upon affection or sexual orientation; gender identity of expression; marital, domestic partnership, civil union status; ancestry and creed. It is illegal for a Landlord to refuse to rent to a person who has a Section 8 voucher or another type of assistance. 15. Termination of Tenancy This Lease may be terminated by the Landlord in accordance with the provisions of New Jersey Landlord Tenant Law and the terms of the lease. During the initial term of the lease or any extension, the Landlord may terminate the tenancy only for serious or repeated violations of material terms of the Lease, including but not be limited to:

1) The failure to pay rent or other payments when due; 2) Repeated late payment, which shall be defined as failure to pay the amount of rent or other

charges due by the 5th day of the month. Four such late payments within a 12-month period shall constitute a repeated late payment;

3) Failure to pay utility bills when Tenant is responsible for paying such bills directly to the supplier of utilities;

4) Misrepresentation of family income or composition; 5) Serious or repeated damage to the dwelling unit, creation of physical hazards in the unit,

common areas, grounds, or parking areas of the Premises;

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6) Criminal activity by Tenant, household member, guest, or other person under Tenant's control,

including criminal activity that threatens the health, safety or right to peaceful enjoyment of the Premises by other Tenants or employees, or any drug-related criminal activity on or off the Premises;

7) Alcohol abuse that the Landlord determines interferes with the health, safety, or right to peaceful enjoyment of the Premises by other Tenants;

8) Weapons or illegal drugs seized in the leased unit by a law enforcement officer; 9) Any fire on the Premises caused by the actions of the Tenant, household members or guests or

neglect; 10) Violation of Federal, State or local law that imposes obligations on the Tenant in connection

with the occupancy or use of the unit or the Premises; and 11) Other good cause as recognized under New Jersey Landlord Tenant Law.

16. Hazards The Tenant shall not undertake, or permit members of the household or guests to undertake any hazardous acts or do anything that will increase the Landlord’s insurance premiums for the Premises. Such action constitutes a material noncompliance. If the unit is damaged by fire, wind, or rain to the extent that the unit cannot be lived in and the damage is not caused by or made worse by the actions of the Tenant, household members, or guests, the Tenant will be responsible for rent only up to the date of the destruction. Additional rent will not accrue until the unit has been repaired to a livable condition.

17. Governing Law This Agreement shall be governed, construed, and interpreted by, through, and under the Laws of the State of New Jersey. 18. Binding Effect The covenants, obligations and conditions herein contained shall be binding on and inure to the benefit of the heirs, legal representatives, and assigns of the parties hereto. 19. Descriptive Headings The descriptive headings used herein are for convenience of reference only and they are not intended to have any effect whatsoever in determining the rights or obligations of the Landlord or Tenant. 20. Construction The pronouns used herein shall include, where appropriate, either gender or both, singular and plural. 21. Non-Waiver No indulgence, waiver, election, or non-election by Landlord under this Agreement shall affect Tenant's duties and liabilities hereunder. 22. Modification The parties hereby agree that this document contains the entire agreement between the parties and this Agreement shall not be modified, changed, altered, or amended in any way except through a written amendment signed by all of the parties hereto. 23. Crime Insurance As required by New Jersey law (NJSA Section 46:8-39), under Title VI of the Housing and Urban Development Act of 1970, the Federal government is subsidizing crime insurance in order to make the same available to residents in the State of New Jersey. Tenant, as a resident, may be eligible to purchase this insurance from the Safety Management Institute, located in Washington, D.C. Tenant may contact

5

this company directly to obtain an application and further information. Tenant may call the following toll free number: (800) 638-8780. Crime insurance is available for Tenants in all habitable property through the New Jersey Underwriters Association, Crime Insurance Indemnity Plan. To apply for crime insurance, contact the New Jersey Underwriters Association, Crime Insurance for Habitable Property, 744 Broad Street, Newark, NJ 07102 directly for an application. 24. Child Protection Window Guard Option Pursuant to New Jersey law (NJSA Section 55:13A-7.14), the Tenant can have window guards installed on the Premises and the public halls by making a written request to Landlord (1) if a child 10 years of age or younger resides on the Premises and (2) if the Tenant lives in a dwelling above the first floor. Residents living on the first floor may only request window guards on windows in public halls above the first floor to which persons in the resident's dwelling have access without having to go out of the building. The Landlord may, at the Landlord's option, recoup the costs associated with the installation of the window guards through increased rent. 25. Truth In Renting Resident acknowledges receipt of the Truth in Renting information, required to be provided by New Jersey law (NJSA Section 46: 8-45). 26. Attachments to the Agreement The Tenant certifies that he/she has received a copy of this Agreement and the following Attachments to this Agreement and understands that these Attachments are part of this Agreement.

• Attachment No. 1 - Unit Inspection Report (as applicable) • Attachment No. 2 - House Rules (as applicable)

27. Lead-Based Warning Disclosure Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not taken care of properly. Lead exposure is especially harmful to young children and pregnant women. Landlord must disclose the presence of known lead-based paint and lead-based paint hazards in the dwelling. Tenants must also receive a federally-approved pamphlet on lead poisoning prevention. LANDLORD'S DISCLOSURE:

a) Presence of lead-based paint or lead-based paint hazards (check one below): _____ Known lead-based paint and/or lead-based paint hazards are present in the housing (explain):_____________________________________________________________________ _____ Landlord has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

b) Records and reports available to the Landlord (check one below): _____ Landlord has provided the Tenant with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents here): ______________________________________________________________________ ______________________________________________________________________

6

_____ Landlord has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the units.

TENANT'S ACKNOWLEDGMENT (initial below):

a) Tenant has received copies of all information listed above. ________ b) Tenant has received the pamphlet Protect Your Family from Lead in Your Home. ________

28. Additional Provisions; Disclosures _________________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Landlord should note above any disclosures about the Premises that may be required under Federal or New Jersey law. The Landlord should also disclose any flood hazards. 29. Signatures

Tenant Printed Name Tenant Signature Date

Landlord Printed Name Landlord Signature Date

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Appendix 022 - Tenant Paid Utility Bills

CERTIFICATION OF LEGAL RESIDENCY IN THE UNITED STATES

(Please read instructions below before completing this form.)

1. To qualify for Federal benefits, the recipient must be a United States citizen or national, or an alien lawfullypresent in the United States.

2. The certification below must be completed in order to receive any benefits provided under theCommunity Development Block Grant – Disaster Recovery Program through the State of New Jersey.

3. Your signature on this claim form constitutes certification.

Instructions: To qualify for relocation advisory services or relocation payments authorized by the UniformRelocation Assistance and Real Property Acquisition Policies Act, a “displaced person” must be a UnitedStates citizen or national, or an alien lawfully present in the United States. The certification below mustbe completed in order to receive any relocation benefits.

Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardshipexceptions.

Please address only the category (Individual or family) that describes your occupancy status. For item (2), please fill in the correct number of persons.

RESIDENTIAL HOUSEHOLDS

(1) Individual. (2) Family.

I certify that I am: (check one) I certify that there are ______ persons in my household and

_____ a citizen or national of the United States ______ are citizens or nationals of the United States and

_____ are aliens lawfully _____ an alien lawfully present in the United States.

____________________________________ ____________________________ Applicant Full Name (please print) Date

___________________________________________________________ Applicant Signature

Applicant Full Name:

Application ID:

Certification of Legal Status April 2017

Appendix 023 - Certification- Legal Status

Appendix 024 - Power of Attorney

WHEN A PUBLIC AGENCY U.S. Department of HousingACQUIRES YOUR PROPERTY and Urban Development

Office of Community Planningand Development

www.hud.gov/relocation

Previous Edition Obsolete 1 HUD-1041-CPD(3/2005)

Introduction

This booklet describes important features of the Uniform Relocation Assistance andReal Property Acquisition Policies Act of 1970, as amended (URA) and providesgeneral information about public acquisition of real property (real estate) that should beuseful to you.

Most acquisitions of real property by a public agency for a Federal project or a project inwhich Federal funds are used are covered by the URA. If you are notified that yourproperty will be acquired for such a project, it is important that you learn your rightsunder this important law.

This booklet may not answer all of your questions. If you have more questions aboutthe acquisition of your property, contact the Agency responsible for the project. (Checkthe back of this booklet for the name of the person to contact at the Agency.) Ask yourquestions before you sell your property. Afterwards, it may be too late.

General Questions

What Right Has Any Public Agency To Acquire My Property?

The Federal Government and every State government have certain powers which arenecessary for them to operate effectively. For example, they have the power to levytaxes and the power to maintain order. Another government power is the power toacquire private property for public purposes. This is known as the power of eminentdomain.

The rights of each of us are protected, however, by the Fifth and FourteenthAmendments of the U.S. Constitution and by State constitutions and eminent domainlaws which guarantee that if a public agency takes private property it must pay "justcompensation" to the owner. The URA provides additional protections, as explained inthis booklet.

Who Made The Decision To Buy My Property?

The decision to acquire a property for a public project usually involves many personsand many determinations. The final determination to proceed with the project is madeonly after a thorough review which may include public hearings to obtain the views ofinterested citizens.

If you have any questions about the project or the selection of your property foracquisition, you should ask a representative of the Agency which is responsible for the

Appendix 025 - HUD Brochure "When an Agency Acquires a Property"

Previous Edition Obsolete 2 HUD-1041-CPD (3/2005)

project.

How Will The Agency Determine How Much To Offer Me For My Property? Before making you an offer, the Agency will obtain at least one appraisal of your property by a competent real property appraiser who is familiar with local property values. The appraiser will inspect your property and prepare a report that includes his or her professional opinion of its current fair market value. After the appraiser has completed his work, a review appraiser will examine the appraisal report to assure that the estimate is fair and the work conforms with professional appraisal standards. The Agency must offer you "just compensation" for your property. This amount cannot be less than the appraised fair market value of the property. "Just compensation" for your property does not take into account your relocation needs. If you are eligible for relocation assistance, it will be additional.

What Is Fair Market Value? Fair market value is sometimes defined as that amount of money which would probably be paid for a property in a sale between a willing seller, who does not have to sell, and a willing buyer, who does not have to buy. In some areas a different term or definition may be used. The fair market value of a property is generally considered to be "just compensation." Fair market value does not take into account intangible elements such as sentimental value, good will, business profits, or any special value that your property may have for you or for the Agency.

How Does An Appraiser Determine The Fair Market Value Of My Property? Each parcel of real property is different and therefore no single formula can be devised to appraise all properties. Among the factors an appraiser typically considers in estimating the value of real property are:

• How it compares with similar properties in the area that have been sold recently.

• How much rental income it could produce.

• How much it would cost to reproduce the buildings and other structures, less any depreciation.

Will I Have A Chance To Talk To The Appraiser? Yes. You will be contacted and given the opportunity to accompany the appraiser on his or her inspection of your property. You may then inform the appraiser of any special features which you believe may add to the value of your property. It is in your best interest to provide the appraiser with all the useful information you can in order to insure that nothing of allowable value will be overlooked. If you are unable to meet with the appraiser, you may wish to have a person who is familiar with your property represent you.


How Soon Will I Receive A Written Purchase Offer? Generally, this will depend on the amount of work required to appraise your property. In the case of a typical single-family house, it is usually possible to make a written purchase offer within 45 to 60 days of the date an appraiser is selected to appraise the property. Promptly after the appraisal has been reviewed (and any necessary corrections obtained), the Agency will determine just compensation and give you a written purchase offer in that amount along with a "summary statement," explaining the basis for the offer. No negotiations are to take place before you receive the written purchase offer and summary statement.

What Is In The Summary Statement Of The Basis For The Offer Of Just Compensation? The summary statement of the basis for the offer of just compensation will include:

• An accurate description of the property and the interest in the property to be acquired.

• A statement of the amount offered as just compensation. (If only part of the property is to be acquired, the compensation for the part to be acquired and the compensation for damages, if any, to the remaining part will be separately stated.)

• A list of the buildings and other improvements covered by the offer. (If there is a separately held interest in the property not owned by you and not covered by the offer (e.g., a tenant-owned improvement), it will be so identified.)

Must I Accept The Agency's Offer? No. You are entitled to present your evidence as to the amount you believe is the fair market value of your property and to make suggestions for changing the terms and conditions of the offer. The Agency will consider your evidence and suggestions. When fully justified by the available evidence of value, the offer price will be increased.

May Someone Represent Me During Negotiations? Yes. If you would like an attorney or anyone else to represent you during negotiations, please inform the Agency. However, the URA does not require the Agency to pay the costs of such representation.

If I Reach Agreement With The Agency, How Soon Will I Be Paid? If you reach a satisfactory agreement to sell your property and your ownership (title to the property) is clear, payment will be made at a mutually acceptable time. Generally,


this should be possible within 30 to 60 days after you sign a purchase contract. If the title evidence obtained by the Agency indicates that further action is necessary to show that your ownership is clear, you may be able to hasten the payment by helping the Agency obtain the necessary proof. (Title evidence is basically a legal record of the ownership of the property. It identifies the owners of record and lists the restrictive deed covenants and recorded mortgages, liens, and other instruments affecting your ownership of the property.)

What Happens If I Don't Agree To The Agency's Purchase Offer? If you are unable to reach an agreement through negotiations, the Agency may file a suit in court to acquire your property through an eminent domain proceeding. Eminent domain proceedings are often called condemnations. If your property is to be acquired by condemnation, the Agency will file the condemnation suit without unreasonable delay. An Agency may also decide not to buy your property, if it cannot reach agreement on a price, and find another property to buy instead.

What Happens After The Agency Condemns My Property? You will be notified of the action. Condemnation procedures vary, and the Agency will explain the procedures which apply in your case. Generally, when an Agency files a condemnation suit, it must deposit with the court (or in an escrow account) an amount not less than its appraisal of the fair market value of the property. You should be able to withdraw this amount, less any amounts necessary to pay off any mortgage or other liens on the property and to resolve any special ownership problems. Withdrawal of your share of the money will not affect your right to seek additional compensation for your property. During the condemnation proceeding, you will be provided an opportunity to introduce your evidence as to the value of your property. Of course, the Agency will have the same right. After hearing the evidence of all parties, the court will determine the amount of just compensation. If that amount exceeds the amount deposited by the Agency, you will be paid the difference, plus any interest that may be provided by law. To help you in presenting your case in a condemnation proceeding, you may wish to employ an attorney and an appraiser. However, in most cases the costs of these professional services and other costs which an owner incurs in presenting his or her case to the court must be paid by the owner.

What Can I Do If I Am Not Satisfied With The Court's Determination? If you are not satisfied with the court judgment, you may file an appeal with the appropriate appellate court for the area in which your property is located. If you are considering an appeal, you should check on the applicable time limit for filing the appeal and consult with your attorney on whether you have a basis for the appeal. The Agency may also file an appeal if it believes the amount of the judgment is too high.


Will I Have To Pay Any Closing Costs? You will be responsible for the payment of the balance on any mortgage and other liens on your property. Also, if your ownership is not clear, you may have to pay the cost of clearing it. But the Agency is responsible for all reasonable and necessary costs for:

• Typical legal and other services required to complete the sale, recording fees, revenue stamps, transfer taxes and any similar expenses which are incidental to transferring ownership to the Agency.

• Penalty costs and other charges related to prepayment of any recorded mortgage on the property that was entered into in good faith.

• Real property taxes covering the period beginning on the date the Agency acquires your property.

Whenever possible, the Agency will make arrangements to pay these costs directly. If you must incur any of these expenses yourself, you will be repaid--usually at the time of closing. If you later discover other costs for which you should be repaid, you should request repayment from the Agency immediately. The Agency will assist you in filing a claim. Finally, if you believe that you were not properly repaid, you may appeal the decision to the Agency.

May I Keep Any Of The Buildings Or Other Improvements On My Property? Very often, many or all of the improvements on the property are not required by the Agency. This might include such items as a fireplace mantel, your favorite shrubbery, or even an entire house. If you wish to keep any improvements, please let the Agency know as soon as possible. If you do arrange to keep any improvement, the Agency will deduct only its salvage value from the purchase price you would otherwise receive. (The salvage value of an item is its probable selling price if offered for sale on the condition that the buyer will remove it at his or her own expense.) Of course, if you arrange to keep any real property improvement, you will not be eligible to receive a relocation payment for the cost of moving it to a new location.

Can The Agency Take Only A Part Of My Property? Yes. But if the purchase of only a part of your property reduces the value of the remaining part(s), you will be paid for the loss in value. Also, if any remaining part would have little or no utility or value to you, the Agency will offer to buy that remaining part from you. Occasionally, a public project will increase the value of the part which is not acquired by the Agency. Under some eminent domain laws, the amount of such increase in value is deducted from the purchase payment the owner would otherwise receive.


Will I Have To Pay Rent To The Agency After My Property Is Acquired? If you remain on the property after the acquisition, you may be required to pay a fair rent to the Agency. Such rent will not exceed that charged for the use of comparable properties in the area.

How Soon Must I Move? If possible, a mutually agreeable date for the move will be worked out. Unless there is an urgent need for your property (e.g., your occupancy would present a health or safety emergency), you will not be required to move without at least 90 days advance written notice. If you reach a voluntary agreement to sell your property, you will not be required to move before you receive the agreed purchase price. If the property is acquired by condemnation, you cannot be required to move before the estimated fair market value of the property has been deposited with the court so that you can withdraw your share. If you are being displaced from your home, you will not be required to move before a comparable replacement home is available to you.

Will I Receive Relocation Assistance? Title II of the URA requires that certain relocation payments and other assistance must be provided to families, individuals, businesses, farms, and nonprofit organizations when they are displaced or their personal property must be moved as a result of a project that is covered by the URA. The Agency will furnish you a full explanation of any relocation assistance to which you may be entitled. If you have any questions about such assistance, please contact the Agency. In order for the Agency to fulfill its relocation obligations to you, you must keep the Agency informed of your plans.

My Property Is Worth More Now. Must I Pay Capital Gains Tax On The Increase? Internal Revenue Service (IRS) Publication 544 explains how the Federal income tax would apply to a gain or loss resulting from the sale or condemnation of real property, or its sale under the threat of condemnation, for public purposes. If you have any questions about the IRS rules, you should discuss your particular circumstances with your personal tax advisor or your local IRS office.

I'm A Veteran. How About My VA Loan? After your VA home mortgage loan has been repaid, you will be permitted to obtain another VA loan to purchase another property. Check on such arrangements with your nearest Veterans Administration Office.


Is It Possible To Donate Property? Yes. You may donate your property or sell it to the Agency for less than its fair market value. The Agency must obtain an appraisal of the property and offer just compensation for it, unless you release the Agency from these obligations.

Additional Information If you have any questions after reading this booklet, contact the Agency and discuss your concerns with the Agency representative. Agency: Address: Office Hours: Telephone Number: Person to Contact:

RELOCATION ASSISTANCE U.S. Department of HousingTO TENANTS DISPLACED and Urban DevelopmentFROM THEIR HOMES Office of Community Planning

and Developmentwww.hud.gov/relocation

Previous Edition Obsolete 1HUD-1042-CPD

(06/2016)

Introduction

This booklet describes the relocation payments and other relocation assistanceprovided under the Uniform Relocation Assistance and Real Property AcquisitionPolicies Act of 1970, as amended (URA) to tenants displaced from their homes. Thisincludes any family or individual that must move as a direct result of rehabilitation,demolition or acquisition for a project in which Federal funds are used.

If you are notified that you will be displaced, it is important that you do not move beforeyou learn what you must do to receive the relocation payments and other assistance towhich you are entitled.

This booklet may not answer all of your questions. If you have more questions aboutyour relocation, contact the Agency responsible for the project. (Check the back of thisbooklet for the name of the person to contact at the Agency.) Ask your questions beforeyou move. Afterwards, it may be too late.

Summary of Relocation Assistance

As an eligible tenant displaced from your home, you will be offered the followingadvisory and financial assistance:

• Advisory Services. This includes referrals to comparable and suitable replacementhomes, the inspection of replacement housing to ensure that it meets establishedstandards, help in preparing claim forms for relocation payments and otherassistance to minimize the impact of the move.

• Payment for Moving Expenses. You may choose either a:

∗ Payment for Your Actual Reasonable Moving and Related Expenses, or

∗ Fixed Moving Expense and Dislocation Allowance, or

∗ A combination of both, based on circumstances.

• Replacement Housing Assistance. To enable you to rent, or if you prefer, buy acomparable or suitable replacement home, you may choose either:

Pursuant to Public Law 105117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional and extremely unusual hardship to a qualifying spouse, parent, or child as defined at 49 CFR 24.208(h). All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States.

Appendix 026 - HUD Brochure "Relocation Assistance When Tenants Displaced From Their Homes

Previous Edition Obsolete 2 HUD-1042-CPD

(06/2016)

∗ Rental Assistance, or

∗ Purchase Assistance.

If you disagree with the Agency's decision as to the relocation assistance for which youare eligible, you may appeal that decision.

General Questions

How Will I Know I Am Eligible For Relocation Assistance?

You should receive a written notice explaining your eligibility for relocation assistance.You should not move before receiving that notice. If you do, you may not receiverelocation assistance.

How Will The Agency Know How Much Help I Need?

You will be contacted at an early date and personally interviewed by a representative ofthe Agency to determine your relocation needs and preferences for replacementhousing and advisory services. The interviewer will ask certain questions about you andother members of your household, including questions about your income. It is to youradvantage to provide the information so that the Agency can assist you in moving with aminimum of hardship. The information you give will be kept in confidence.

How Soon Will I Have To Move?

If possible, a mutually agreeable date for the move will be worked out. You will be givenenough time to make plans for moving. Unless there is a health or safety emergency,you will not be required to move without at least 90 days advance written notice of (1) atleast one "comparable replacement home" that is available to you and (2) the earliestdate by which you must move.

What Is A Comparable Replacement Home?

A comparable replacement home is:

• Decent, safe, and sanitary.

• Functionally equivalent to (and equal or better than) your present home.

• Actually available for you to rent.

• Affordable.

• Reasonably accessible to your place of employment.

• Generally as well located with respect to public and commercial facilities, such asschools and shopping, as your present home.

• Not subject to unreasonable adverse environmental conditions.

• Available to all persons regardless of race, color, religion, sex, or national origin.


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What is Decent, Safe, and Sanitary Housing?

Decent, safe, and sanitary housing is housing that:

• Meets applicable housing and occupancy requirements.

• Is structurally sound, weathertight, and in good repair.

• Contains a safe, adequate electrical wiring system.

• Has adequate living space for the occupants.

• Has a kitchen with a sink, hot and cold running water, and connections for a stoveand refrigerator (if you were displaced from a housekeeping unit).

• Has a separate, complete bathroom with hot and cold running water.

• Has heating as required by climatic conditions.

• Has an unobstructed exit to safe, open space at ground level.

• Meets standards protecting occupants from lead-based paint hazards.

• If you are person with a physical disability, is free of any barriers which wouldpreclude your reasonable use of the unit.

Will The Agency Help Me Find A Replacement Home?

Yes. You will be provided with referrals to housing that has been inspected to ensurethat it meets established standards. If possible, you will be referred to at least threecomparable replacement homes. The maximum financial assistance for which you mayqualify will be based on the cost of the most representative comparable replacementhome that is available to you. Promptly after you become eligible for relocationassistance, the Agency will inform you of such unit and the maximum paymentavailable.

Once the Agency representative has a clear understanding of your needs andpreferences, he or she will work with you to assure that you are given the best possiblechoice of housing. The Agency will offer you appropriate transportation to inspect theseunits.

If you would like to move to government-owned housing or obtain a Housing ChoiceVoucher (HCV) let the Agency representative know of your interest. Generally, aneligible displaced person receives preference for such long term housing assistance.You will be given assistance in completing any required application forms.

What If I Find My Own Replacement Housing?

You have every right to find your own replacement housing. However, before you rentor buy, ask the Agency to inspect the unit to make sure that it is decent, safe, andsanitary. If the housing unit is not decent, safe, and sanitary, you will not receive areplacement housing payment.

What If I Encounter A Problem In Obtaining Housing Of My Choice?


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If you encounter a problem in buying or renting housing of your choice, notify theAgency immediately. The Agency will look into the matter and try to resolve it. You willreceive this help whether you were referred to the housing unit or found it yourself.

If you are unable to buy or rent a housing unit because of discriminatory practices onthe part of a real estate broker, rental agent, lender, or a property owner, the Agencywill help you file a formal housing discrimination complaint with the U.S. Department ofHousing and Urban Development or the appropriate State or local fair housing agency.

What Other Services Will I Receive?

In addition to help in obtaining a comparable replacement home, other assistance, asnecessary, will be provided in order to minimize the impact of your move. Thisassistance may include referral to appropriate public and private agencies that provideservices concerning housing financing, employment, health, welfare, or legalassistance. The range of services depends on the needs of the person being displaced.You should ask the Agency representative to tell you about the specific services that

will be available to help you and your family.

What Is a Payment For Actual Reasonable Moving and Related Expenses?

You may choose to receive a relocation payment to cover the reasonable cost of yourmove. If you choose a Payment For Actual Reasonable Moving And Related Expenses,you may include in your claim the reasonable and necessary costs for:

• Transportation for you and your family.

• Packing, moving and unpacking your household goods.

• Disconnecting and reconnecting household appliances and other personal property(e.g., telephone and cable TV).

• Storage of household goods, as may be necessary.

• Insurance for the replacement value of your property during the move and necessarystorage.

• The replacement value of property lost, stolen or damaged in the move (but notthrough your neglect) if insurance is not reasonably available.

The Agency will explain all eligible moving costs, as well as those which are not eligible.You must be able to account for any costs that you incur, so keep all your receipts.Select your mover with care. The Agency can help you select a reliable and reputablemover.

You may elect to pay your moving costs yourself and be repaid by the Agency or, if youprefer, you may have the Agency pay the mover. In either case, let the Agency knowbefore you move.

What Is A Fixed Moving Expense And Dislocation Allowance?

If you choose a Fixed Moving Expense and Dislocation Allowance, you will receive anallowance which is based on the number of rooms in your home or the number of rooms


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of furniture you will be moving, as shown on a schedule. The Agency has a copy of theschedule and will help you decide whether choosing this allowance is in your bestinterest.

If you do not have a large amount of personal property to move, this payment should bemore advantageous. No special documentation is required to support your claim. Youneed only move your personal property and complete the appropriate claim form in orderto receive your payment.

How Much Rental Assistance Will I Receive?

You may be eligible to receive Rental Assistance for a 42-month period. The assistance iscomputed in the following manner:

The assistance needed for one month is determined by subtracting the "base monthly rent"for your present home from the cost of rent and utilities for your new home (or acomparable replacement home, if that cost is lower). That monthly need, if any, ismultiplied by 42, to determine the total amount that you will receive. This amount will bepaid directly to you. The Agency must provide the assistance in monthly installments orother periodic payments. Generally, the base monthly rent for your present home is thelesser of: (1) the monthly rent and average monthly cost for utilities, or (2) thirty (30)percent of your average monthly gross household income, if you are low-income based onHUD income limits.

Examples: Let's say that the monthly rent and average cost for utilities for your presenthome are $250; the monthly rent and estimated average utility costs for a comparablereplacement home are $350; and your monthly gross income is $700. In this case your"base monthly rent" would be $210 because you are low-income and that amount (30percent of your income) is less than the monthly cost of rent and utilities at your presenthome ($250).

• If you rent a replacement home for $360 per month, including estimated averagemonthly utility charges, you will receive $5,880. That amount is 42 times $140 (thedifference between the "base monthly rent" for your present home ($210) and thecost for a comparable replacement home ($350)).

• If you rent a replacement home for $310, including estimated average monthlyutility charges, you will receive $4,200. That amount is 42 times $100 (thedifference between the "base monthly rent" for your present home ($210) and theactual cost of your new home ($310)).

To qualify for rental assistance, you must rent and occupy a decent, safe, and sanitaryhome within one year after the date you move. However, the Agency will extend thisperiod for good cause.

If I Decide to Buy, Rather Than Rent, How Much Assistance Will I Receive?

If you buy a replacement home, you may be eligible for assistance to make a down


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payment equal to the amount you would receive if you rented a comparable replacementhome (i.e., 42 times the amount obtained by subtracting the "base monthly rent" for yourpresent home from the monthly rent and estimated average monthly utility costs for acomparable replacement home). A down payment assistance payment will be paid in alump sum.

Example: Assuming the information in the prior examples, the downpayment assistancepayment would be $5,880. That amount is 42 times $140 (the difference between the"base monthly rent" for your present home ($210) and the monthly rent and estimatedaverage monthly utilities cost for a comparable replacement home ($350). The full amountof the payment must be applied to the purchase of the replacement dwelling.

Must I File A Claim To Obtain A Relocation Payment?

Yes. You must file a claim for each relocation payment. The Agency will, however, provideyou with the required claim form, help you to complete it, and explain the type ofdocumentation, if any, that you must submit in order to receive the payment.

If you must pay any relocation expenses before you move (e.g., a security deposit when yousign a lease for your new home), discuss your financial needs with the Agency. Whilerefundable deposits are not covered by URA payments, you may be able to obtain anadvance payment to meet these costs. An advance payment may be placed in "escrow" orpaid directly to a contractor to ensure that the move will be completed on a timely basis.

You must file your claim within 18 months after the date you move. However, it is to youradvantage to file as soon as possible after you move. The sooner you submit your claim,the sooner it can be processed and paid. If you are unable to file your claim within 18months, ask the Agency to extend this period.

Be careful not to confuse this 18-month period with the 12-month period within which youmust rent (or buy) and occupy a replacement dwelling in order to be eligible for areplacement housing payment.

You will be paid promptly after you file an acceptable claim. If there is any questionregarding your right to a relocation payment or the amount of the payment, you will benotified, in writing, of the problem and the action you may take to resolve the matter.

Will I Have To Pay Rent To The Agency Before I Move?

If the Agency acquires the property in which you live, you may be required to pay a fair rentto the Agency for the period between the acquisition of the property and the date that youmove. Such rent will not exceed the market rent for comparable properties in the area.

Do I Have To Pay Federal Income Taxes On My Relocation Payments?

No. Section 216 of the URA states that you need not report relocation payments as part ofyour gross income for Federal tax purposes. For information on State or local income taxes,you should check with the State or local income tax office in your area or with your personal


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tax advisor.

What If I Don't Receive The Required Assistance. Can I Appeal?

If you disagree with the Agency's decision as to your right to relocation assistance or theamount of a payment, or the adequacy of the housing to which you have been referred, youmay appeal the decision to the Agency.

The Agency will inform you of its appeal procedures. At a minimum, you will have 60 daysto file your appeal with the Agency after you receive written notification of the Agency'sdetermination on your claim. Your appeal must be in writing. However, if you need help,the Agency will assist you in preparing your appeal.

If you are a low- or moderate-income person and are dissatisfied with the Agency'sdetermination on your appeal, you may have an additional right to request administrativereview of that decision (e.g., by HUD or the State).

You can expect a fair decision on any appeal. However, if you are not satisfied with the finaladministrative decision on your appeal, you may seek review of the matter by the courts.

I Have More Questions. Who Will Answer Them?

If you have further questions after reading this booklet, contact the Agency and discuss yourconcerns with an Agency representative.

Agency :

Address:

Office Hours:

Telephone No.:

Person to Contact:

RELOCATION ASSISTANCE U. S. Department of HousingTO DISPLACED HOMEOWNER and Urban DevelopmentOCCUPANTS Office of Community Planning

and Developmentwww.hud.gov/relocation

Previous Edition Obsolete 1HUD-1044-CPD(06/2016)

Introduction

This booklet describes the relocation payments and other relocation assistanceprovided under the Uniform Relocation Assistance and Real Property AcquisitionPolicies Act of 1970, as amended (URA) to most homeowners whose home isacquired by a public agency for a Federal project or a project in which Federal funds areused.

To be eligible for the assistance described in this booklet, you must have owned and

occupied your home for at least 90 days before the Agency offered to buy it. If you have

owned and occupied your home for less than 90 days, you may still be eligible for relocationassistance, contact the Agency for additional information.

If you are notified that your home will be acquired and you will be displaced, it isimportant that you do not move before you learn what you must do to receive therelocation payments and other assistance to which you are entitled.

Pursuant to Public Law 105-117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional and extremely unusual hardship to a qualifying spouse, parent, or child as defined at 49 CFR 24.208(h). All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States.

This booklet may not answer all of your questions. If you have more questions, contactthe Agency responsible for the project. (Check the back of this booklet for the name ofthe person to contact at the Agency.) Ask your questions before you move. Afterwards,it may be too late.

Summary of Relocation Assistance

As an eligible displaced homeowner occupant, you will be offered the following advisoryand financial assistance:

Advisory Services. This includes referrals to comparable replacement homes, theinspection of replacement housing to ensure that it meets established standards, help inpreparing claim forms for relocation payments and other assistance to minimize theimpact of the move.

(Form has been revised. See last page.)

Appendix 027 - HUD Brochure "Relocation Assistance to Displaced Homeowner- Occupants"

H49515

Underline


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• Payment for Moving Expenses. You may choose either a:

Payment for Your Actual Reasonable Moving and Related Expenses, or A Fixed Moving Payment, or A combination of both, based on circumstances.

• Replacement Housing Payment. To enable you to buy or, if you prefer, rent a comparable replacement home, you may choose either:

Purchase Assistance, or Rental Assistance.

If you disagree with the Agency's decision as to the relocation assistance for which you are eligible, you may appeal that decision.

General Questions

Will I Be Paid For My Property Before I Have To Move? If you reach an agreement to sell your property to the Agency, you will not be required to move before you receive the agreed purchase price. If the property is acquired through an eminent domain proceeding, you cannot be required to move before the estimated fair market value of the property has been deposited with the court. (You should be able to withdraw this amount immediately, less any amounts necessary to pay off any mortgage or other liens on the property and to resolve any special ownership problems. Withdrawal of your share of the money will not affect your right to seek additional compensation for your property.)

Will I Have To Pay Rent To The Agency Before I Move? You may be required to pay a fair rent to the Agency for the period between the acquisition of your property and the date that you move. The rent will not exceed that charged for the use of comparable properties.

How Will I Know I Am Eligible For Relocation Assistance? You should receive a written notice explaining your eligibility for relocation assistance. You will become eligible for relocation assistance on the date you receive the Agency's written offer of "just compensation" to purchase your home. You should not move before receiving that purchase offer. If you do, you may not receive relocation assistance. For information about the acquisition of your home, ask the Agency for a copy of the booklet, "When a Public Agency Acquires Your Property."

How Will The Agency Know How Much Help I Need?


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You will be contacted at an early date and personally interviewed by a representative of the Agency to determine your relocation needs and preferences for replacement housing and advisory services. The interviewer will ask certain questions about you and other members of your household. It is to your advantage to provide the information so that the Agency can assist you in moving with a minimum of hardship. The information you give will be kept in confidence.

How Soon Will I Have To Move? If possible, a mutually agreeable date for the move will be worked out. You will be given enough time to make plans for moving. Unless there is a health or safety emergency, you will not be required to move without at least 90 days advance written notice of (1) at least one "comparable replacement home" that is available to you and (2) the earliest date by which you must move.

What Is A Comparable Replacement Home? A comparable replacement home is:

• Decent, safe, and sanitary.

• Functionally equivalent to your present home.

• Actually available for you to buy.

• Affordable.

• Reasonably accessible to your place of employment.

• Generally as well located with respect to public and commercial facilities, such as schools and shopping, as your present home.

• Not subject to unreasonable adverse environmental conditions.

• Available to all persons regardless of race, color, religion, sex, or national origin.

What is Decent, Safe, and Sanitary Housing? Decent, safe, and sanitary housing is housing that:

• Meets local housing and occupancy requirements. Additionally, it is housing that:

• Is structurally sound, weather tight, and in good repair.

• Contains a safe, adequate electrical wiring system.

• Has adequate living space for the occupants.

• Has a kitchen with a sink, hot and cold running water, and connections for a stove and refrigerator.

• Has a separate, complete bathroom with hot and cold running water and sewage system.

• Has heating as required by climatic conditions.

• Has an unobstructed exit to safe, open space at ground level.

• Is free of any barriers that would preclude your reasonable use of the unit, if you are


(06/2016)

a person with a physical disability.

Will The Agency Help Me Find A Replacement Home? Yes. You will be provided with referrals to comparable replacement housing. If possible, you will be referred to at least three comparable replacement homes. The maximum financial assistance for which you may qualify will be based on the cost of the most representative comparable replacement home that is available to you. When the Agency gives you its initial written purchase offer, it will typically inform you at that time, or shortly thereafter, of your eligibility for relocation assistance, identifying the most comparable replacement home and explain the maximum amount of relocation assistance available to you. Once the Agency representative has a clear understanding of your needs and preferences, he or she will work with you to assure that you are given the best possible choice of housing and offer you transportation to inspect these units. If there is a mortgage on your present home, the Agency will refer you to lenders that can provide mortgage financing for your new home. If the money paid for your old home is applied to the purchase of your new home, there should not be any increase in the number or amount of your monthly payments for mortgage interest and principal.

What If I Find My Own Replacement Housing? You have every right to find your own replacement housing. However, before you buy or rent, ask the Agency to inspect the unit to make sure that it is decent, safe, and sanitary. If the housing unit is not decent, safe, and sanitary, you will not receive a replacement housing payment.

What If I Encounter A Problem In Obtaining Housing Of My Choice? If you encounter a problem in buying or renting housing of your choice, notify the Agency immediately. The Agency will look into the matter and try to resolve it. You will receive this help whether you were referred to the housing unit or found it yourself. If you are unable to buy or rent a housing unit because of discriminatory practices on the part of a real estate broker, rental agent, lender, or a property owner, the Agency will help you file a formal housing discrimination complaint with the U.S. Department of Housing and Urban Development or the appropriate State or local fair housing agency.

What Other Services Will I Receive? In addition to help in obtaining a comparable replacement home, other assistance, as necessary, will be provided in order to minimize the impact of your move. This assistance may include referral to appropriate public and private agencies that provide


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services concerning housing financing, employment, health, welfare, or legal assis-tance. The range of services depends on the needs of the person being displaced. You should ask the Agency representative to tell you about the specific services that will be available to help you and your family.

What Is a Payment For Actual Reasonable Moving And Related Expenses? You are entitled to a relocation payment to cover the actual reasonable cost of your move. If you choose a Payment For Actual Reasonable Moving And Related Expenses, you may include in your claim the reasonable costs for:

• Transportation for you and your family.

• Packing, moving and unpacking your household goods.

• Disconnecting and reconnecting household appliances and other personal property (e.g., telephone and cable TV).

• Storage of household goods, as may be necessary.

• Insurance for the replacement value of your property during the move and necessary storage.

• The replacement value of property lost, stolen or damaged in the move (but not through your neglect) if insurance is not reasonably available.

The Agency will explain all eligible moving costs, as well as those which are not eligible. You must be able to account for any costs that you incur, so keep all your receipts. Select your mover with care. The Agency can help you select a reliable and reputable mover. You may elect to pay your moving costs yourself and be repaid by the Agency or, if you prefer, you may have the Agency pay the mover. In either case, let the Agency know before you move.

What Is A Fixed Moving Payment? If you choose a Fixed Moving Payment, you will receive a payment based on the number of rooms of furniture you will be moving, as shown on the Fixed Residential Moving Cost Schedule. The Agency has a copy of the schedule and will help you decide whether choosing this payment is in your best interest. If you do not have an unusually large amount of personal property to move and are capable of moving yourself, this payment should be more advantageous to you. No special documentation is required to support your claim. You need only move your personal property and complete the appropriate claim form in order to receive your payment.

I Want To Buy Another Home. How Much Purchase Assistance Will I Receive? To help you buy a comparable replacement home, you will receive Purchase Assistance


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equal to the sum of the following three costs:

• Purchase Price Differential. If the cost of replacement housing exceeds the amount the Agency pays for your present home, you may be eligible for a payment to cover the difference. The Agency will inform you in writing of the location and cost of comparable replacement housing (and explain the basis of its determination) so that you will know in advance how much assistance you may receive. That information should help you decide how much you wish to pay for replacement housing.

You are free to purchase any decent, safe and sanitary housing unit of your choice. If the purchase price is less than the cost of a comparable replacement home, the payment will be limited to the actual difference. If it exceeds the cost of a comparable replacement home, the payment will be based on the cost of a comparable home.

Examples: Let's say that the Agency pays $120,000 to purchase your home and that a comparable replacement home costs $130,000.

If you pay $129,000 for a replacement home, you would receive a $9,000

differential payment (the difference between the Agency's payment for the acquisition of your home and the cost of your replacement home).

If you pay $132,000 for the replacement home, you would receive a $10,000

differential payment (the difference between the Agency's acquisition payment and the cost of the comparable replacement home).

• Mortgage Interest Differential Payment. This amount covers the "present value" of the additional costs required to finance the purchase of a replacement home that result if the interest rate you must pay for a new mortgage is higher than the interest rate on the mortgage on your present home. It also covers other debt service costs. The payment is based on the lesser of: the mortgage balance on your present home or your new mortgage amount. To be eligible, the mortgage on your home must have been a valid lien for at least 180 days before the Agency's initial written purchase offer for your home.

You should provide the Agency with a copy of your mortgage(s) as soon as possible. Based on that information and the prevailing terms and conditions of new mortgage financing, the Agency will compute the approximate mortgage interest differential payment for which you will be eligible, inform you of that amount and explain the conditions on which it is based. The payment will be made available with the purchase price differential in a timely manner to reduce the amount you must borrow to buy your new home.

• Incidental Expenses. This amount covers those extra costs typically charged when one buys real property, such as the cost of preparing the deed and recording fees;


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the cost of title insurance, revenue stamps and transfer taxes (not to exceed the cost for comparable replacement housing); loan application, loan origination and appraisal fees; the cost of a credit report; and for other costs such as certification of structural soundness, home inspection and termite inspection. It does not cover prepaid expenses, such as property taxes and insurance.

Remember, your total replacement housing payment is the sum of the purchase price differential, mortgage interest differential, and incidental expenses. To qualify for the payment, you must purchase and occupy a decent, safe and sanitary replacement home within one year after the later of: the date you move or the date you receive the final payment for the acquisition of your present home. However, the Agency will extend this period for good cause.

If I Decide To Rent, Rather Than Buy, Another Home, How Much Assistance Will I Receive? If you decide to rent rather than buy a replacement home, you may be eligible to receive

Rental Assistance. The assistance covers a 42-month period and is computed in the following manner. The assistance needed for one month is based on the difference between the market rent for your present home (including utilities), as determined by the agency, compared to a comparable rental dwelling available on the market (including utilities). That monthly need, if any, is multiplied by 42 to determine the total amount that you will receive. This amount will be paid directly to you in monthly installments or other periodic payments.

Examples: Let's say that the monthly "market rent" and average cost for utilities for your present home are $250 and the monthly rent and estimated average utility costs for a comparable replacement home are $350. If you rent a replacement home for $360 per month, including estimated utility

charges, you will receive $4,200. That amount is 42 times $100 (the difference between the market rent for your present home ($250) and the cost for a comparable replacement home ($350)).

If you rent a replacement home for $310, including estimated average monthly utility

charges, you will receive $2,520. That amount is 42 times $60 (the difference between the "base monthly rent" for your present home ($250) and the actual cost of your new home ($310)).

To qualify for rental assistance, you must rent and occupy a decent, safe, and sanitary home within one year after the later of: the date you move or the date you receive the final payment for the acquisition of your present home. However, the Agency will extend this period for good cause. The amount of rental assistance cannot exceed the


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computed purchase price differential.

Must I File A Claim To Obtain A Relocation Payment? Yes. You must file a claim for each relocation payment. The Agency will provide you with the required claim forms, help you to complete them, and explain the type of documentation, if any, that you must submit in order to receive your relocation pay-ments. If you must pay any relocation expenses before you move (e.g., a deposit when you contract for the purchase of a new home), discuss your financial needs with the Agency. You will be able to obtain an advance payment to meet these costs. An advance payment to purchase a home may be placed in "escrow." An advance payment for moving expenses may be paid directly to the moving contractor to ensure that the move will be completed on a timely basis. You must file your claim within 18 months after the date you move or receive the final payment for the acquisition of your present home. However, it is to your advantage to file as soon as possible after you move. The sooner you submit your claim, the sooner it can be processed and paid. If you are unable to file your claim within 18 months, ask the Agency to extend this period. Be careful not to confuse this 18-month period with the 12-month period within which you must buy or rent and occupy a replacement dwelling in order to be eligible for a replacement housing payment. You will be paid promptly after you file an acceptable claim. If there is any question regarding your right to a relocation payment or the amount of the payment, you will be notified, in writing, of the problem and the action you may take to resolve the matter.

Do I Have To Pay Federal Income Taxes On My Relocation Payments? No. Section 216 of the URA states that you need not report relocation payments as part of your gross income for Federal tax purposes. For information on State or local income taxes, you should check with the State or local income tax office in your area or with your personal tax advisor.

What If I Don't Receive The Required Assistance. Can I Appeal? If you disagree with the Agency's decision as to your right to relocation assistance or the amount of a payment, or the adequacy of the housing to which you have been referred, you may appeal the decision to the Agency. The Agency will inform you of its appeal procedures. At a minimum, you will have 60 days to file your appeal with the Agency. Your appeal must be in writing. However, if


(06/2016)

you need help, the Agency will assist you in preparing your appeal. If you are a low- or moderate-income person and are dissatisfied with the Agency's determination on your appeal, you may have an additional right to request administrative review of that decision (e.g., by HUD or the State). The Agency will explain whether this option is available. You can expect a fair decision on any appeal. However, if you are not satisfied with the final administrative decision on your appeal, you may seek review of the matter by the courts.

I Have More Questions. Who Will Answer Them? If you have any questions after reading this booklet, contact the Agency and discuss your concerns with an Agency representative. Agency: Address: Office Hours: Telephone Number: Person to Contact:

(NOTE: Updated to incorporate MAP-21 statutory changes to the URA effective on 10/01/2014. Please note the current URA regulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP-21 changes. For additional information on MAP-21 changes to the URA for HUD programs, refer to HUD Notice CPD-14-09 at thefollowing website: http://portal.hud.gov/hudportal/documents/huddoc?id=14-09cpdn.pdf.)

Appendix 028 - Method/Manner of Notice Delivery

(insert letterhead of entity)

CERTIFICATION OF RECEIPT (date)

General Information Notice Name: ________________________ Address: ________________________ ________________________ The above referenced party hereby acknowledges and affirms the following: ______(name of representative)________________________ , a duly authorized representative of (insert name of funded entity) a General Information Notice, in accordance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended ( 42 U.S.C. 4601, et seq.), pertaining to the (acquisition, rehabilitation and/or demolition) of the property located at 100 North Capital Street, Trenton, New Jersey on ___________(date)_______________________. ______________________________________________ __________________________ Signature Date


[01/06] App. 29-1

(date)

Dear :

On (date) , (property owner) submitted an application to the (Grantee) for financial assistance under a program funded by the Department of Housing and Urban Development (HUD). The proposed project involves [acquisition] [rehabilitation] [demolition] and/or [conversion] of the property located at (address) . Because Federal funds are planned for use in this project, the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (URA) [and/or section 104(d) of the Housing and Community Development Act of 1974, as amended] may apply to persons in occupancy at the time the application was submitted for HUD funding. However, if you choose to occupy this property subsequent to the application for federal financial assistance, as a new tenant you will not be eligible for relocation payments or assistance under the URA [and/or section 104(d)].

This notice is to inform you of the following information before you enter into any lease agreement and/or occupy the property located at the above address:

♦ You may be displaced by the project.♦ You may be required to relocate temporarily.♦ You may be subject to a rent increase.♦ You will not be entitled to any relocation payments or assistance

provided under the URA [and/or section 104(d)]. If you have tomove or your rent is increased as a result of the above project, youwill not be reimbursed for any such rent increase or for any costs orexpenses you incur in connection with a move as a result of theproject.

Please read this notification carefully prior to signing a rental agreement and moving into the project. If you should have any questions about this notice, please contact (Grantee) at (address and telephone number) . Once you have read and have understood this notice, please sign the statement below if you still desire to lease the unit.

Sincerely,

(name and title)

Appendix 029 - General Information NoticeTenant Non-Displaced

MOVE-IN NOTICE (GUIDEFORM NOTICE TO PROSPECTIVE TENANT)



[01/06] App. 29-2

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * I have read the above information and understand the conditions under which I am moving into this project. Print Name of Tenant(s) Signature(s) Address and Unit Number Date NOTE: This is a guideform. It should be revised to reflect the project circumstances.

1378 CHG-6Appendix 2a

GUIDEFORM GENERAL INFORMATION NOTICE NONRESIDENTIAL TENANT NOT DISPLACED


(date)

Dear ___________:

(City, County, State, Public Housing Authority (PHA), other)_____, is interested in rehabilitating the property you currently occupy at (address) for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________________ program.

The purpose of this notice is to inform you that you will not be displaced in connection with the proposed project.

If the project application is approved and federal financial assistance provided, you may be required to move temporarily so that the rehabilitation can be completed.

If federal financial assistance is provided for the proposed project, you will be protected by a federal law known as the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA). One of the URA protections for nonresidential tenants (businesses, non-profit organizations, or farms) temporarily relocated is that if your operation will be shut down for any length of time due to the rehabilitation project, at our option, you may be: 1) Temporarily relocated and reimbursed for all reasonable out of pocket expenses; or 2) determined to be displaced and eligible for relocation assistance and payments as a displaced person under the URA.

(NOTE: Pursuant to Public Law 105-117, aliens not lawfully present in the United States are not eligible for relocation assistance, unless such ineligibility would result in exceptional hardship to a qualifying spouse, parent, or child. All persons seeking relocation assistance will be required to certify that they are a United States citizen or national, or an alien lawfully present in the United States.)

We urge you not to move at this time. If you choose to move, you will not be provided relocation assistance.

Please remember:

• This is not a notice to vacate the premises.• This is not a notice of relocation eligibility.

App. 2a-1 [10/06]

Appendix 029 - General Information Notice Business Non-Displaced

1378 CHG-6 Appendix 2a

You will be contacted soon so that we can provide you with more information about the proposed project. If the project is approved, we will make every effort to accommodate your needs. In the meantime, if you have any questions about our plans, please contact: (name)______________________, (title)____________, (address)_________________________________, (phone)___________________. Sincerely, (name and title)__________________________ Enclosure ===============================================================NOTES. 1. The case file must indicate the manner in which this notice was delivered (e.g.,

personally served or certified mail, return receipt requested) and the date of delivery. (See Paragraph 2-3 I of Handbook 1378.)


[10/06] App. 2a-2


(date)

Dear ___________:

(City, County, State, Public Housing Authority (PHA), other)______, is interested in (acquiring, rehabilitating, demolishing)______ the property you currently occupy at (address)___ for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________________ program.

The purpose of this notice is to inform you that you may be displaced as a result of the proposed project. This notice also serves to inform you of your potential rights as a displaced person under a federal law known as the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA). You may be eligible for relocation assistance and payments under the URA, if the proposed project receives HUD funding and if you are displaced as a result of acquisition, rehabilitation or demolition for the project.

• This is not a notice to vacate the premises.

• This is not a notice of relocation eligibility.

If you are determined to be eligible for relocation assistance in the future, you may be eligible for: 1) Relocation advisory services including help to you find another place to live; 2) At least 90 days advance written notice of the date you will be required to move; 3) Payment for your moving expenses; and 4) Replacement housing payments to enableyou to rent, or if you prefer to purchase, a comparable replacement home. You will alsohave the right to appeal the agency’s determination, if you feel that your application forassistance was not properly considered. The enclosed HUD brochure, "RelocationAssistance To Tenants Displaced From Their Homes" provides an explanation of thisassistance and other helpful information.


Please be advised that you should continue to pay your rent and meet any other obligations as specified in your lease agreement. Failure to do so may be cause for eviction. If you choose to move or if you are evicted prior to receiving a formal notice of

App. 3-1 [10/06]

Appendix 029 - General Information Notice Tenant Displacement

GUIDEFORM GENERAL INFORMATION NOTICE RESIDENTIAL TENANT TO BE DISPLACED



relocation eligibility you will not be eligible to receive relocation assistance. It is important for you to contact us before making any moving plans. Again, this is not a notice to vacate the premises and does not establish your eligibility for relocation payments or assistance at this time. If you are determined to be displaced and are required to vacate the premises in the future, you will be informed in writing. In the event the proposed project does not proceed or if you are determined not to be displaced, you will also be notified in writing. If you have any questions about this notice or the proposed project, please contact (name)______________________, (title)____________, (address)_________________________________, (phone)___________________. Sincerely, (name and title)__________________________ Enclosure ===============================================================NOTES 1. The case file must indicate the manner in which this notice was delivered (e.g.,


2. This is a guideform. It should be revised to reflect the circumstances. 3. Optional paragraphs for displaced residents of public housing projects (may be

modified based on the PHA’s resident return policy):

“Even though you will be provided all of the assistance the URA requires for a permanent move, the Authority believes that every resident displaced from the site should have the right to reapply for occupancy once this project is complete. For this reason, after project completion, every resident who receives assistance as a “displaced person” will be contacted and offered an opportunity to reapply for occupancy in the newly-revitalized community. Furthermore, because you will be a former occupant who was “displaced” from the site, you will also receive a priority preference to return. In the event the number of those who request to return and qualify for housing exceeds the number of units available, rating and ranking criteria will be used to identify those who will be offered a unit at the site until all available units are filled. If you do return, the Authority may help defray the costs of the return move. If you have Replacement Housing Payments not yet spent or obligated, you may be asked to forfeit these payments as a condition for returning to public housing, since this assistance will no longer be necessary to meet your housing needs. Such assistance, if not forfeited, must be considered as income and may affect your eligibility and rent.”

[10/06] App. 3-2

1378 CHG-6Appendix 3a

(date)

Dear ___________:

(City, County, State, Public Housing Authority (PHA), other)______, is interested in (acquiring, rehabilitating, demolishing)______ the property you currently occupy at (address)___ for a proposed project which may receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________________ program.

The purpose of this notice is to inform you that your (business, nonprofit organization or farm) may be displaced as a result of the proposed project. This notice also serves to inform you of your potential rights as a displaced person under a federal law known as the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA). You may be eligible for relocation assistance and payments under the URA if the proposed project receives HUD funding assistance and if you are displaced as a result of acquisition, rehabilitation or demolition for the project.

• This is not a notice to vacate the premises.

• This is not a notice of relocation eligibility.

If you are determined to be eligible for relocation assistance in the future, youmay be eligible for: 1) Relocation advisory services including help to find you a replacement location; 2) At least 90 days advance written notice of the date you will be required to move; 3) Payment for your moving and reestablishment expenses. You also have the right to appeal the agency’s determination, if you feel that your application for assistance was not properly considered. The enclosed HUD brochure, "Relocation Assistance To Displaced Businesses, Nonprofit Organizations, and Farms" provides an explanation of this assistance and other helpful information.


Please be advised that you should continue to pay your rent and meet any other obligations as specified in your lease agreement. Failure to do so may be cause for eviction. If you choose to move or if you are evicted prior to receiving a formal notice of

App. 3a-1 [10/06]

Appendix 029 - General Information Notice Business Displacement

GUIDEFORM GENERAL INFORMATION NOTICE NONRESIDENTIAL TENANT TO BE DISPLACED


1378 CHG-6 Appendix 3a

relocation eligibility you will not be eligible to receive relocation assistance. It is important for you to contact us before making any moving plans. Again, this is not a notice to vacate the premises and does not establish your eligibility for relocation payments or assistance at this time. If you are determined to be displaced and are required to vacate the premises in the future, you will be informed in writing. In the event the proposed project does not proceed or if you are determined not to be displaced, you will also be notified in writing. If you have any questions about this notice or the proposed project, please contact (name)______________________, (title)____________, (address)_________________________________, (phone)___________________. Sincerely, (name and title)__________________________ Enclosure ===============================================================NOTES 1. The case file must indicate the manner in which this notice was delivered (e.g.,



[10/06] App. 3a-2


GUIDEFORM NOTICE OF NONDISPLACEMENT TO RESIDENTIAL TENANT


(date)

Dear ___________________:

On ___(date) _, the ____(City, County, State, Public Housing Authority (PHA), other) , notified you of proposed plans to rehabilitate the property you currently occupy at (address)_______ for a project which could receive funding assistance from the U.S. Department of Housing and Urban Development (HUD) under the _______________________ program. On ____(date)_____, the project was approved and will receive federal funding. Repairs will begin soon.

• This is a notice of nondisplacement. You will not be required to movepermanently as result of the rehabilitation.

This notice guarantees you the following:

1. Upon completion of the rehabilitation, you will be able to lease and occupy yourpresent apartment or another suitable, decent, safe and sanitary apartment in thesame building/complex under reasonable terms and conditions. *

2. If you must move temporarily so that the rehabilitation can be completed, you willbe reimbursed for all of your extra expenses, including the cost of moving to andfrom temporary housing and any increased interim housing costs. The temporaryunit will be decent, safe and sanitary, and all other conditions of the temporarymove will be reasonable.

Since you will have the opportunity to occupy a newly rehabilitated apartment, I urge you not to move. (If you do elect to move for your own reasons, you will not receive any relocation assistance.) We will make every effort to accommodate your needs. Because federal funding is involved in this project, you are protected by the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended. Of course, you must continue to comply with the terms and conditions of your lease.

If you have any questions, please contact (name) , at (phone) , (address) . This letter is important to you and should be

retained.

Sincerely, (name and title) .

App. 4-1 [10/06]

Appendix 030 - Notice of Non-Displacement- Residential Tenant


NOTES. 1. The case file must indicate the manner in which this notice was delivered (e.g.,


2. This is a guideform. It should be revised to reflect the circumstances. * Based on the applicable HUD program regulations, if “reasonable terms and

conditions,” are defined, one of the following statements or other language may also be required in this Notice: a. Under HOME at 24 CFR 92.353(c)(2)(C)(1): “Your new lease will be for a

term of not less than one year at a monthly rent will remain the same or, if increased, your new monthly rent and estimated average utility costs will not exceed: 1) if you are low income, the total tenant payment as defined by HUD (under 24 CFR 5.628), or (2) 30% of the monthly gross household income, if you are not low income.”

b. Under CDBG at 24 CFR 570.606(b)(2)(D)(1): “Your monthly rent will remain the same or, if increased, your new rent and estimated average utility costs will not exceed 30% of the household’s average monthly gross income.”

c. Under Section 221 Mortgage Insurance Programs at 24 CFR 221.795(i): “Your monthly rent and estimated average utility costs will not exceed the amount approved by HUD.”

[10/06] App. 4-2

1378 CHG-6

Appendix 5

App. 5-1 [03/10]

GUIDEFORM NOTICE OF ELIGIBILITY FOR

RELOCATION ASSISTANCE -- 180-DAY HOMEOWNER OCCUPANT

(INVOLUNTARY ACQUISITION)


(date)

Dear ___________________:

On ___(date) _, the ____(City, County, State, Public Housing Authority

(PHA), other) , notified you of proposed plans to acquire the property you currently

own and occupy at (address)_______ for a project which could receive funding

assistance from the U.S. Department of Housing and Urban Development (HUD) under

the _______________________ program. On ____(date)_____, the project was

approved and will receive federal funding.

It has been determined that you will be displaced by the project. Since you are being

displaced in connection with this federally funded project, you will be eligible for relocation

assistance and payments under the Uniform Relocation Assistance and Real Property

Acquisition Policies Act (URA).

This is your Notice of Eligibility for relocation assistance

The effective date of your eligibility is _______________. (Insert date of

Initiation of Negotiations, see 49 CFR 24.2(a)(15) or applicable HUD

program regulations)

(NOTE: Pursuant to Public Law 105-117, aliens not lawfully present in the United

States are not eligible for relocation assistance, unless such ineligibility would result

in exceptional hardship to a qualifying spouse, parent, or child. All persons seeking

relocation assistance will be required to certify that they are a United States citizen

or national, or an alien lawfully present in the United States.)

To carry out the project, it will be necessary for you to move. However, you do not

need to move now. You will be provided written notice of the date by which you will be

required to move. This date will be no less than 90 days from the date comparable

replacement housing has been made available to you.

Enclosed is a brochure entitled, "Relocation Assistance to Displaced Homeowner

Occupants." Please read the brochure carefully. It explains your rights and provides

additional information on eligibility for relocation payments and what you must do in order

to receive these payments.

Appendix 031 - Notice of Eligibility for Relocation Assistance Homeowner

1378 CHG-6

Appendix 5

[03/10] App. 5-2

The relocation assistance to which you are entitled includes:

Relocation Advisory Services. Including counseling and other assistance to

help you find another home and prepare to move.

Payment for Moving Expenses. You may choose: (1) a payment for your

actual reasonable moving and related expenses, or (2) a fixed moving

payment in the amount of $________ based on the URA Fixed Residential

Moving Cost Schedule, or (3) a combination of both.

Replacement Housing Payment. You may be eligible for a replacement

housing payment in order to help you purchase a comparable replacement

home. A replacement housing payment is comprised of the following three

payments: 1) Price differential payment 2) Mortgage interest differential

payment and 3) Incidental expenses. A more detailed description of these

three payments may be found in the enclosed brochure.

Listed below are three comparable replacement dwellings that you may wish to

consider for your replacement home. If you would like, we can arrange transportation for

you to inspect these and other replacement dwellings.

Name and Tele. No.

Address Asking Price of Person to Contact

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

We believe that the dwelling located at (address) is the most

representative of your present home and it will be used to calculate your maximum

replacment housing payment. Please contact us immediately if you believe this dwelling is

not comparable to your current home. We can explain our basis for selecting this dwelling

as most representative of your current home and discuss your concerns.

Since the dwelling located at _(address)__________________ would cost

$_________ more than the amount offered for your present home, you may be eligible

for a maximum purchase price differential payment of $__________ , in addition to other

eligible mortgage interest differential payment and incidental payment costs to purchase

your replacement home. If you purchase a decent, safe and sanitary replacement

dwelling that costs less than $_________, your replacement housing payment will be

based on the actual purchase price of that home.

1378 CHG-6

Appendix 5

App. 5-3 [03/10]

Should you wish to rent (rather than buy) a replacement home, let us know. We

will help you find comparable rental housing and explain your eligibility for a rental

assistance payment.

Please note that all replacement housing must be inspected in order to ensure it is

decent, safe and sanitary before any replacement housing payments are made.

If you have any questions about this letter and your eligibility for relocation

assistance and payments, please contact (name) , (title) at

(phone) , (address) before you make any moving plans.

He/she will assist you with your move to a new home and help ensure that you preserve

your eligibility for all relocation payments to which you may be entitled.

Remember, do not move or commit to the purchase or lease of a replacement

home before we have a chance to further discuss your eligibility for relocation assistance.

This letter is important to you and should be retained.

Sincerely,

(name and title) .

Enclosure

NOTES.

1. The case file must indicate the manner in which this notice was delivered (e.g.,

personally served or certified mail, return receipt requested) and the date of

delivery. (See Paragraph 2-3 I of Handbook 1378.)


App. 6-1 [03/10]


URA RELOCATION ASSISTANCE

RESIDENTIAL TENANT


(date)

Dear ___________:

On ___(date) _, the ____(City, County, State, Public Housing Authority

(PHA), other) , notified you of proposed plans to (acquire, rehabilitate, or

demolish)____ the property you currently occupy at (address)_______ for a project

which could receive funding assistance from the U.S. Department of Housing and Urban

Development (HUD) under the _______________________ program. On

____(date)_____, the project was approved and will receive federal funding.

It has been determined that you will be displaced by the project. Since you are being

displaced in connection with this federally funded project, you will be eligible for relocation

assistance and payments under the Uniform Relocation Assistance and Real Property

Acquisition Policies Act (URA).












required to move. This date will be no less than 90 days from the date comparable

replacement housing has been made available to you.

Enclosed is a brochure entitled, "Relocation Assistance to Tenants Displaced From

Their Homes." Please read the brochure carefully. It explains your rights and provides

additional information on eligibility for relocation payments and what you must do in order

to receive these payments.

1378 CHG-6 Appendix 031 - Notice of Eligibility for Relocation Assistance Appendix 6

Residential Tenant

1378 CHG-6

Appendix 6

[03/10] App. 6-2


Relocation Advisory Services. Including counseling and other assistance to

help you find another home and prepare to move.

Payment for Moving Expenses. You may choose: (1) a payment for your

actual reasonable moving and related expenses, or (2) a fixed moving

payment in the amount of $________ based on the URA Fixed Residential

Moving Cost Schedule, or (3) a combination of both.

Replacement Housing Payment. You may be eligible for a replacement

housing payment to rent or buy a replacement home. The payment is based

on several factors including: (1) the monthly rent and cost of utility services

for a comparable replacement dwelling, (2) the monthly rent and cost of

utility services for your present home, and (3) for low-income persons, 30

percent of your average monthly gross household income. This payment is

calculated on the difference in the old and new housing costs for a one-

month period and multiplied by 42.

Listed below are three comparable replacement dwellings that you may wish to

consider for your replacement home. If you would like, we can arrange transportation for

you to inspect these and other replacement dwellings.

Address Rent & Utility Costs Contact Info

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

We believe that the dwelling located at (address) is the most representative of

your present home. The monthly rent and the estimated average monthly cost of utilities for

this dwelling is $ and it will be used to calculate your maximum replacement

housing payment. Please contact us immediately if you believe this dwelling is not

comparable to your current home. We can explain our basis for selecting this dwelling as

most representative of your current home and discuss your concerns.

Based on the information you have provided about your income and the rent and

utilities you now pay, you may be eligible for a maximum replacement housing payment of

approximately $ (42 x $____), if you rent the dwelling identified above as the most

comparable to your current home or rent another dwelling of equal cost.

1378 CHG-6

Appendix 6

App. 6-3 [03/10]

Replacement housing payments are not adjusted to reflect future rent increases or

changes in income. This is the maximum amount that you would be eligible to receive. If

you rent a decent, safe and sanitary home where the monthly rent and average estimated

utility costs are less than the comparable dwelling, your replacement housing payment will

be based on the actual cost of the dwelling. We will not base your payment on any dwelling

that is not a comparable replacement home. All replacement housing payments must be

paid in installments. Your payment will be paid in #_ installments.

Should you choose to purchase (rather than rent) a decent, safe and sanitary

replacement home, you would be eligible for a downpayment assistance payment which is

equal to your maximum replacement housing payment, $_________*. Let us know if you

are interested in purchasing a replacement home and we will help you locate such housing.

Please note that all replacement housing must be inspected in order to ensure it is

decent, safe and sanitary before any replacement housing payments are made.


assistance and payments, please contact (name) , (title) at

(phone) , (address) before you make any moving plans.

He/she will assist you with your move to a new home and help ensure that you preserve

your eligibility for all relocation payments to which you may be entitled.


home before we have a chance to further discuss your eligibility for relocation assistance.


Sincerely,

___(name & title)_____

Enclosure/s

NOTES.

* At the agency’s discretion, a downpayment assistance payment that is less than

$5,250 may be increased to any amount not to exceed $5,250. (See 49 CFR

24.402(c)(1))


personally served or certified mail, return receipt requested) and the date of delivery.

(See Paragraph 2-3 I of Handbook 1378.)


3. Optional paragraphs for displaced residents of public housing projects (may be

modified based on the PHA’s resident return policy):

1378 CHG-6

Appendix 6

[03/10] App. 6-4

“Even though you will be provided all of the assistance the URA requires for a

permanent move, the Authority believes that every resident displaced from the

site should have the right to reapply for occupancy once this project is complete.

For this reason, after project completion, every resident who receives assistance

as a “displaced person” will be contacted and offered an opportunity to reapply

for occupancy in the newly-revitalized community. Furthermore, because you

will be a former occupant who was “displaced” from the site, you will also

receive a priority preference to return.

In the event the number of those who request to return and qualify for

housing exceeds the number of units available, rating and ranking criteria will be

used to identify those who will be offered a unit at the site until all available units

are filled. If you do return, the Authority may help defray the costs of the return

move. If you have Replacement Housing Payments not yet spent or obligated, you

may be asked to forfeit these payments as a condition for returning to public

housing, since this assistance will no longer be necessary to meet your housing

needs. Such assistance, if not forfeited, must be considered as income and may

affect your eligibility and rent.”

.

1378 CHG-6

Appendix 7

App. 7-1 [03/10]


URA RELOCATION ASSISTANCE - NONRESIDENTIAL

(Businesses, Nonprofit Organizations, or Farms)


(date)

Dear _____________________:

On (date) , we notified you of our proposed project and that your (business,

nonprofit organization or farm) located at ___(address) _______ may be displaced as a

result of that project. On (date) , the project was approved and will be receiving HUD

funding assistance under (name of HUD program/s ). It has been determined that your

(business, nonprofit organization or farm) will be displaced by the project. Since your

(business, nonprofit organization or farm) is being displaced in connection with this

federally funded project, you will be eligible for relocation assistance and payments under

the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA).












required to move. This date will be no less than 90 days from the date of such notice.

Enclosed is a brochure entitled, "Relocation Assistance to Displaced Businesses,

Nonprofit Organizations and Farms." Please read the brochure carefully. It explains your

rights and provides additional information on eligibility for relocation payments and what

you must do in order to receive these payments. Do not move or commit yourself to

renting or purchasing a replacement location at this time. A representative of the

Agency will assist you with your move and help ensure that you preserve your eligibility for

all relocation payments for which you may be entitled. Some of the relocation assistance for

which you are entitled includes:

Relocation Advisory Services to help you find a suitable replacement

location and to provide other assistance in connection with your move.

Appendix 031 - Notice of Eligibility for Relocation Assistance Non-Residential

1378 CHG-6

Appendix 7

[03/10] App. 7-2

Payment for Moving and Reestablishment Expenses. You may be eligible

for: (1) A payment for your actual reasonable moving and related expenses;

including payment for reestablishment expenses of up to $10,000, or (2) a

fixed moving payment for your actual reasonable and necessary moving and

reestablishment expenses. The fixed moving payment ranges from a

minimum of $1,000 to a maximum of $20,000 depending on a number of

factors.


assistance and payments, please contact (name) , (title)______ at

(phone) , (address) .


location before we have a chance to further discuss your eligibility for relocation assistance.


Sincerely,

(name and title)

Enclosure/s

NOTES.


personally served or certified mail, return receipt requested) and the date of delivery.

(See Paragraph 2-3 I of Handbook 1378.)


Appendix 032 - 90 Day Move Notice (Sample)

__ (date)________ Mr. John Doe Maplewood Apartments 856 S. Van Gordon Court Apartment XXX Lakewood, CO 80226 Dear (Maplewood Resident) :

On (insert date Notice of Eligibility was issued) we notified you that you would need to move from the Maplewood Apartments for the renovation project. As you know, we are planning to undertake extensive renovations both inside and out.

This is a 90-Day Move Notice. You will not be required to move prior (_enter date) . As we informed you in the Notice of Eligibility, you are entitled to relocation payments and other assistance in accordance with Federal regulations implementing the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA) of 1970, as amended.

If you are interested in moving in advance of (insert move date) we are happy to work with you. Please contact us if you have any questions or I can be of any assistance.

Phone # for the Hearing Impaired _____________________ Sincerely,

(name) (title)

CHRIS CHRISTIE

DEPARTMENT OF COMMUNITY AFFAIRS

SANDY RECOVERY DMSION

Governor 101 SOUTH BROAD STREET

PO Box823

KIM GUADAGNO

Lt. Governor

TRENTON, NJ 08625-0823

CHARLES A. RICHMAN

Commissioner

g ••c-··

AFFAIRS

VIA CERTIFIED MAIL

John Doe123 Main StreetTrenton, NJ 08610

June 2, 2017

Re: NOTICE OF ELIGIBILITY FOR URA RELOCATION ASSISTANCE

Our records indicate that you are an occupant at 987 Washington Street, Toms River, N.J., on or after October 29, 2012, and due to Superstorm Sandy will have to vacate your housing unit.

It has been determined that you will be permanently displaced by the project, which could receive funding assistance from the U.S. Department of Housing and Urban Development (HUD), under the Community Development Block Grant Disaster Recovery Program. Since you are being displaced in connection with this federally funded project, you will be eligible for relocation assistance and payments under the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA).

• This is your Notice of Eligibility for relocation assistance.

• The effective date of your eligibility is ---'0=6,=/2=0:a..:..V-=-1.:.....7 __________ _

(NOTE: Pursuant to Public Law 105-117, aliens not lawfully present in the United States

are not eligible for relocation assistance, unless such ineligibility would result in exceptional

hardship to a qualifying spouse, parent, or child. All persons seeking relocation assistance

will be required to certify that they are a United States citizen or national, or an alien

lawfully present in the United States.)

90-Day Notice: To carry out the project, it will be necessary for you to move. However, you donot need to move now. You will not be required to move prior to 09/20117.

You were provided with the brochure, Relocation Assistance to Tenants Displaced From Their Homes. Please read the brochure carefully. It explains your rights and provides additional information on eligibility for relocation and what you must do to receive payment.

New Jersey is an £,qua{ Opporumily Employer • Printed on Recycled paper and Recyclable

Appendix 033 - Combined 90 Day and Notice of Eligibility Sample


Relocation Advisory Services. Including counseling and other assistance to help you find another home and prepare to move.

Payment for Moving Expenses. You may choose: (I) a payment for your actual reasonable moving and related expenses, or (2) a fixed moving payment in the amount of $1,600.00, based on the URA Fixed Residential Moving Cost Schedule, or (3) a combination of both.

Replacement Housing Payment. You may be eligible for a replacement housing payment to rent or buy a replacement home. The payment is based on several factors including: (1) the monthly rent and cost of utility services for a comparable replacement dwelling, and (2) the monthly rent and cost of utility services for your present home, This payment is calculated on the difference in the old and new housing costs for a one month period and multiplied by 42.

Listed below are three comparable replacement dwellings that you may wish to consider for your replacement home.

Address

I. 1860 Lincoln Ave., Trenton

2. 1789 Washington Rd., York

3. 1801 Jefferson Ct., Hamilton

Rent + Utilities Contact Info

3450.00 + 240.00 123-456-9810

3500.00 + 240.00 109-876-5432

2999.00 + 240.00 Email ONLY

We believe that the dwelling located at 1860 Lincoln Ave., Trenton, N.J. is the most representative of your present home. The monthly rent and the estimated average monthly cost of utilities for this dwelling is $3.740.00 and it will be used to calculate your maximum replacement housing payment. Please contact us immediately if you believe this dwelling is not comparable to your current home. We can explain our basis for selecting this dwelling as most representative of your current home and discuss your concerns.

Based on the information you have provided about your income and the rent and utilities you now pay, you may be eligible for a maximum replacement housing payment of approximately $ 54,400.00 (42 x $ 1200.00), if you rent the dwelling identified above as the most comparable to your current home or rent another dwelling of equal cost.

Replacement housing payments are not adjusted to reflect future rent increases or changes in income. This is the maximum amount that you would be eligible to receive. If you rent a decent, safe and sanitary home where the monthly rent and average estimated utility costs are less than the comparable dwelling, your replacement housing payment will be based on the actual cost of the dwelling. Your payment will be paid in three (3) installments.

Should you choose to purchase (rather than rent) a decent, safe and sanitary replacement home, you would be eligible for a down payment assistance payment which is equal to your maximum replacement housing payment,$ 54,400.00. Let us know if you are interested in purchasing a replacement home and we will help you locate such housing.

Please note that all replacement housing must pass H.U.D. Housing Quality Standard (HQS) Inspection, in order to ensure it is decent, safe and sanitary before housing payments are made.

If you have any questions about this letter and your eligibility for relocation assistance and payments, please contact Jane Smith of the Recovery Division, New Jersey at (434-434-4343) or [email protected] before you make moving plans. He will assist you with your move to a new home and help ensure that you preserve your eligibility for all relocation payments to which you may be entitled.

In the event that you disagree with the determination pertaining to the dwelling identified as comparable to our present unit or the relocation assistance detailed in this notice, you may submit an appeal to the following:

Jane Doe Program Specialist, Housing Recovery Programs Recovery Division New Jersey P.O. Box 111 4321 South Main Street Trenton, New Jersey 08610

[email protected]

Remember, do not move or commit to the purchase or lease of a replacement home before we have a chance to further discuss your eligibility for relocation assistance. This letter is important to you and should be retained.

Sincerely,

Housing Recovery Programs, Sandy Recovery Division

Appendix 034 - Record of Advisory Assistance/ Case Log

Cmus CH.RJSTIE

Govern()r

KIM GUADAGNO Lt. Go1,en,or

Mr. John Doe12 Main StreetTrenton, NJ 08610

�tate of Jletu j{ er%ep DEPARTMENT OF COMMUNITY AFFAIRS

SANDY RECOVERY DIVISION

101 SOUTH BROAJ) STRBF.T

POBox823

TRENTON, NJ 08625-0823

Subject: Uniform Relocation Act - No Return Confirmation

CHARLES A. RICHMAN

Acting Commissioner

Dear Mr. Doe:

This letter is in response to your former landlord's application to the Rental Program. Pursuant to our conversation held on 10/15/14 in regard to your eligibility for Sandy-Displaced Residential Tenants, the Program determined you are eligible for relocation services under the Stafford Act, Section 414. However, on 10/15/14, you indicated that you have no interest in returning to this damaged unit. This letter serves to confirm that decision.

If you have any question, please contact Jane Smith, of the Sandy Recovery Division, New Jersey Department of Community Affairs at 343-343-3434 or [email protected].

Sincerely, Housing Recovery Programs

Nt!w .Jersl!y is w1 fqual Opporlu11ity l:.mployc>r • f'ri11ted on l?l!cycled paper and Ret:vclah/e

Appendix 035 - Stafford Act 414- Correspondence

1' J/;1,, STATE oi: Ni:w J1m�1·:Y :�.·.�: (\

1;::�1): D:�PAtt'l'MENT <Hi CoMMtJ1''1Y AFl'i\rns... .,, , �· 1 .

·�1:

CERTIFIED MAIL- RRR Ms. Jane Smith34 Washington StreetTrenton, NJ 08610

,.

Governor Chris Christie • Lt. Governor Kim Guadagno ·

Commisioner Richard E. Constable. Ill

iv1arch 21 � 2014

Re: Notice or Relocation Eligibility for Displaced Residential Tenants

Dear Ms. Smith:

Our records indicate that you were an occupant of 56 First Street, Toms River, New Jersey on October 29. 20 t 2. and due to SuperStorm Sandy, you may have had to vacate your unil.

The owner ol'thc property has applied for fodcml funds to assist with the rehabilitation of the unit. As a previous occupant of the above-mentioned properly, you may be eligible to move back into your former rental unit. Please contact Jane Smith at 343-343-3434 or via email at [email protected] at the NJ Department of Community Affair's Sandy Recovery Division within thirty (30) <lays of receipt of this notifi�ation. lf you do not respond within that timcframe, you will he determined to have voluntarily decided not to move back to your previous rcntul unit.

r •: t..,

,,.

Very truly yours.

�P(j)-, Stephen P. Grady Assistant Director Housing Recovery Programs Sanely Recovery Division

Appendix 036 - Stafford Act 414- Public Notices

Appendix 037 - Stafford Act 414- Web Notification

Appendix 038 - Option #1 - Individual Case Determination

Memorandum

TO: File

FROM: Samuel Davis, Relocation Specialist

CC: Betty Jones, Program Manager, Sandy Recovery Program

DATE: April 25, 2016

RE: Property Buyout Program – Uniform Relocation Act: Housing of Last ResortPBP2353-0012 – Smith, Jonathan

This tenant has been determined to be permanently displaced and is eligible for rental assistanceunder the Uniform Relocation Act due to the scheduled acquisition of the Property BuyoutProgram (PBP) that is funded through HUD Community Development Block Grant-DisasterRecovery (CDBG-DR).

As per HUD CFR Section 24.404 “Replacement housing of last resort” and PBP’s UniformRelocation Act (URA) Policy and Procedures Manual, when the cost of available comparablehousing exceeds the maximum URA assistance amounts, PBP may be required to provide furtherassistance in order to ensure that the tenant is able to secure comparable replacement housing.

This need was assessed on a case-by-case basis as part of the identification of the mostrepresentative comparable replacement dwelling as detailed on the enclosed worksheet (FormHUD-40061).

Based on the availability of comparable replacement housing and an assessment of theresidential real estate market in the immediate community where the displacement dwelling islocated, without “last resort housing” assistance this tenant would be unable to find comparablehousing.

There is little, if any, comparable replacement housing available to displaced persons within theproject area that result in a replacement housing payment below the $7,200 limitation. Therefore,last resort housing assistance is necessary for this case and the program will provide areplacement housing payment in excess of the limits set forth in § 24.401 or § 24.402.

Approved by:

______________________________________Leslie W. Jones

Director – Disaster Recovery ProgramsDepartment of Housing and Community Development

Appendix 039 - Option #2(a) - Relocation Plan Sample

Relocation Plan

Mobile Home Park123 Main Street

Trenton, NJ

TrentonCommunity Development Department

Trenton, NJ 08610

June 1, 2017

Table of Contents 1. Existing Project Summary ......................... Error! Bookmark not defined. 2. Brief Descrption of Project ........................................................................ 4

3. Households to be Displaced ………………………………………………8 4. Relocation Destinations …………………………………………………..11

5. Permanent Relocation Assistance ………………………………………………12 5.1 - Permanent Relocation Policy 5.2 - Permanent Moves - Moving Expenses 5.3 - Permanent Moves - Advisory Services 5.4 - Permanent Moves - Replacement Housing Payment 5.5 - Permanent Moves - Security Deposits/Credit Checks 5.6 - Permanent Moves - Housing of Last Resort 5.7 - Permanent Moves - Resident Legal Status 5.8 - Permanent Moves - Relocation Benefit Waivers 5.9 - Permanent Moves - Duplicative Payment/Duplication of Benefits 5.10 - Permanent Moves - Expeditious Payments 5.11 - Permanent Moves - Advance Payments 5.12 - Permanent Moves - Other General Requirements 6. Relocation Resources ……..…………………………………….19 7. Relocation Advisory Services …… ............................................................... 19 8. Overcoming Potential Impediments to Relocation .................................................... 22 9. Relocation Costs ......................... Error! Bookmark not defined.

10. Resident Notification ......................... Error! Bookmark not defined. 11. Relocation Recordkeeping and Notices ..................... Error! Bookmark not defined. 12. Appeals ...................................................................... 26 13. Appendix ...................................................................... 28

5.6 Permanent Moves – Housing of Last Resort Prescribed within the URA at 49 CFR 24.401(b) the cap on a replacement housing payment to a homeowner-occupant for an eligible 90-day homeowner may not exceed $31,000 and renter occupant may not exceed $7,200 unless comparable replacement housing is not available within a displaced person’s financial means. Whenever the payment ceiling is insufficient to provide comparable replacement housing, additional assistance or alternative assistance must be provided. As detailed in HUD Handbook 1378 in Section 3-8 (A.) exceeding the payment ceiling is commonplace. To ensure that a displaced person is not unduly burdened financially, Trenton will provide additional cash assistance. This policy is based on the determination that without the additional cash assistance the buyout of the mobile home owners and their relocation cannot advance to completion in a timely manner and utilization of this method is cost effective, as the site remains in the critical path for continued flooding. After consideration of all elements of this project that based on the local housing market analysis, the availability of comparable housing units and the current unsafe and hazardous conditions on the site, use of last resort housing through the provision of additional cash assistance is cost effective approach.

Appendix 040 - Option #2(b) - Project-wide Sample

RENTAL REHABILIATON PROGRAM UNIFORM RELOCATION ACT (URA) - LAST RESORT HOUSING MEASURES

Program Description:

The Rental Rehabilitation Program (RRP) provides up to $75,000 in Community Development Block Grant – Disaster Recovery (CDBG-DR) grants to property owners for the rehabilitation of residential rental property that has suffered disaster damage. Eligible costs includes, but are not limited to, soft costs (permits, surveys, architectural drawings, environmental, lead-based paint and asbestos assessments), hard cost of rehabilitation (electrical, plumbing, replacement of fixtures, painting, flooring, and window and door replacement), temporary relocation assistance to income qualified in-place tenants, permanent relocation assistance to displaced tenants and reasonable and appropriate required legal fees.

Relocation Requirements:

Applications for assistance shall include a current rent roll that includes household name, size, income and current rent. Due to the income qualification post-rehabilitation for RRP assisted units, along with the potential of addressing over-crowded housing situations, households who will not meet the post-rehabilitation occupancy standards shall be determined to be permanently and involuntarily displaced. All households who shall be deemed “displaced” for the RRR rerolled unit CDBG-DR funded shall be eligible for relocation assistance under the URA, in accordance with the requirements found at 49 CFR Part 24.

Housing of Last Resort:

In accordance with the requirements found at 49 CFR 24.404(a)(2), this determination to exceed the monetary limits established under the provisions found at 49 CFR 24.401 or 24.402 and provide, as appropriate, additional assistance, is based on the following:

1. In the community that has been identified as a disaster-eligible impacted area, there is little, ifany, comparable replacement housing available for households who will be deemed “displaced” fromunits receiving assistance from RRP.

2. Due to the damage and immediate impact relating to the loss of decent, safe and sanitary,affordable rental housing, RRP cannot advance to completion and satisfy the timeliness requirementsimposed by HUD in the CDBG-DR grant award without last resort housing assistance

3. The provision of additional assistance that exceeds the monetary limits established under theURA is the most cost reasonable, as tenant-based or project-based housing subsidies are not available.Additionally, the last resort housing assistance is cost effective as special measures such as newconstruction, physical relocation of housing, and purchase of land and/or housing exceeds the RRPCDBG-DR resources allocated to the program.

1

Comparable #_________ Case File #________________________

Factors Comparable Unit

Address

Type of Unit

Stories/Style

Lot Size

Type of Construction

Age (in years)

Condition

Area of Living Space (sq. ft)

No. Rooms/Bedrooms/Baths

Basement

Parking/No. of Cars

Type of Heating/Fuel

Type of Air Conditioning

Neighborhood

Transportation (distance)

Current Work (distance)

High School/Grade School (distance)

Neighborhood Shopping (distance)

Religious Facility (distance)

Sale Price or Rent/Utility Costs

Other

Date of Inspection

Date Available

Unit is decent, safe, and sanitary? ____ Yes ____ No

Unit meets local building and/or housing code? ____ Yes ____ No

Unit passes a Lead-based Paint Visual Assessment (if pre-1978) ____ Yes ____ No

Unit is functionally equivalent in sq. ft., # bedrooms & amenities ____ Yes ____ No

Unit has unobstructed egress to safe, open space at ground level? ____ Yes ____ No

I hereby certify that I have personally inspected the above described property, and the property is decent, safe, and sanitary, without major

structural defects and available for rent/purchase.

Further, I hereby certify that I, or any friend, relative, family member or associate have no interest in the real property detailed here, nor will any

party aforementioned receive any benefit or compensation for any referral, sale or lease.

Agent’s Signature:___________________________________________ Date:______________________

Appendix 041 - Individual Comparable Replacement

Unit Individual Comparable Replacement Dwelling

2

Individual Comparable Replacement Dwelling

Comparable #_________ Case File #________________________

INSERT PHOTOGRAPHS:

form HUD-40061 (4/2005)Page 1 of 2Previous editions are obsolete.

Address

Type of Unit

Stories / Style

Lot Size

Type of Construction

Age (in years)

Condition

Area of Living Space (sq. ft.)

No.Rooms/Bedrooms /Baths / / / / / / / /

Basement

Parking/No. of Cars

Type of Heating /Fuel / / / /

Type of Air Conditioning

Neighborhood

Transportation (distance)

Current Work (distance)

High School/Grade School (distance) / / / /

Neighborhood Shopping (distance)

Religious Facility (distance)

Sale Price or Rent/Utility Costs $ $ $ $

Other

Date of Inspection

Date Available

Most Representative Comparable Replacement Dwelling

(Check "Comparable no.1, 2, or 3" and complete Comments)

Prepared By Date (mm/dd/yyyy) Approved by Date (mm/dd/yyyy)

Factors (see back of page) Displacement Dwelling Comparable No.1 Comparable No.2 Comparable No.3

1. Agency 2. Project 3. Household 4. Select One 5.Case Number

Owner

Tenant

Privacy Act Notice: This information is needed to determine whether you are eligible to receive a payment to help you rent or buy a new home. You are notrequired by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses or it may take longer to pay you.This information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970. The informationmay be made available to a Federal agency for review.

Comments: Include appropriate analysis and correlation of data. If Agency makes adjustment to the asking price for a comparable replacement dwellingto reflect the anticipated sale price, indicate the basis for the adjustment. For rental units, indicate utilities included in rent and provide estimates for otherutility costs. Indicate availability of any housing subsidy. If condominium or cooperative, indicate required fees. (Continue on back of page)

Comments continued on back of page Yes No

Selection of Most RepresentativeComparable Replacement Dwellingfor Computing a Replacement Housing Payment

U.S. Department of Housingand Urban DevelopmentOffice of of Community Planningand Developmemt

OMB Approval No. 2506-0016(exp.04 /30/2018)

Public reporting burden for this collection of information is estimated to average 1.0 hour. This includes the time for collecting, reviewing, and reportingthe data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970,and implementing regulations at 49 CFR Part 24 and will be used for determining the most comparable and available replacement housing and its cost to beused by Agencies in computing a replacement housing payment for displaced persons. Response to this request for information is required in order toreceive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currentlyvalid OMB control number.

Appendix 042 - Selection Comparable Replacement Unit

form HUD-40061 (4/2005)Page 2 of 2Previous editions are obsolete.

Factors Examples

Type of Unit Detached,Row, End Row, Townhouse, Highrise Apartment, Mobile Home (Indicate whether this is subsidized housing)

Stories 1, 11/2, 2, 21/2, Split Level, Split Foyer

Style Colonial, Cape, Ranch, Contemporary, Tudor, Mediterranean

Type of Frame, Masonry, Pre-Fab, Stone, Concrete Block, Concrete, Veneer (wood, brick, or aluminum siding)Construction

Condition Poor, Fair, Good, Very Good, Excellent

Basement Full, Partial (1/2), None; Finished or Unfinished

Parking Attached, Built-In, Detached, Carport Paved Open Area, Unpaved Open Area, None

Type of Forced Air, Hot Water, Electric, Heat Pump, Steam, Space Heater, Solar, NoneHeating

Type of Fuel Natural Gas, Propane Gas, Oil, Electric, Coal, Solar

Type of Air Central, Wall, Window, NoneConditioning

Neighborhood Poor, Fair, Good, Very Good, Excellent. (Based on characteristics such as vacancy levels, quality and maintenance of dwellings,landscaping, Street Maintenance, Trash Pickup, and Nonconforming land uses)

Other Swimming Pool, Fireplace, Patio, Porch, Greenhouse

Comments Continued:

Comments continued on a separate page Yes No

form HUD-40057 (06/2016)Page 1 of 3

Previous editions are obsolete

2. Have all members of the household moved to the same dwelling? Yes No (If "no", attach a list of the names of all membersand the addresses to which they moved.)

Claim for Replacement HousingPayment for 90-Day Homeowner-Occupant (49 CFR 24.401)

U.S. Department of Housingand Urban DevelopmentOffice of Community Planningand Development

OMB Approval No. 2506-0016(exp. 04/30/2018)

For Agency Name of Agency Project Name or Number Case NumberUse Only

(1) Purchase Price of Comparable Replacement Dwelling(To be provided by the Agency)

(2) Purchase Price of the Dwelling You Moved To (Not applicable for owner- occupant who elects to rent)

(3) Lesser of line 6(1) or 6(2)

(4) Price Paid by Agency for Dwelling That You Moved From

(5) Price Differential Amount (Subtract line 6(4) from line 6(3).If amount on line 6(4) exceeds amount on line 6(3), enter 0) This is themaximum amount for a homeowner occupant who elects to rent.

(6) Incidental Expenses (From line 7(10))

(7) Mortgage Buydown Payment and Other Debt Service Costs(To be determined by Agency. See instructions in Item 8)

(8) Total Amount of Replacement Housing Payment Claim(Add lines 6(5), 6(6), and 6(7))

(9) Amount Previously Received, if any

(10) Amount Requested (Subtract line 6(9) from line 6(8))

6. Computation of Replacement Housing Payment (A homeowner-occupantwho elects to rent should complete only items 1, 3, 4 & 5) To Be Completed By Claimant For Agency Use Only

When did you When did you move When did you moveDwelling Address buy this unit? to this unit? out of this unit?

Instructions. This form is for the use of families and individuals applying for a replacement housing payment under the Uniform Relocation Assistanceand Real Property Acquisition Policies Act of 1970 (URA) for a 90-day homeowner occupant who elects to buy a replacement home. A homeowner-occupantwho decides to rent rather than buy should also use form HUD-40058. The Agency will help you complete this form. HUD also provides informationon these requirements and other guidance materials on its website at: www.hud.gov/relocation. If the full amount of your claim is not approved, the Agencywill provide you with a written explanation of the reason. If you are not satisfied with the Agency's determination, you may appeal that determination.The Agency will explain how to make an appeal.

All claims for payment by a homeowner-occupant must be filed within 18 months after the latest of: a) the date of displacement or b) thedate of final payment for the acquisition of the real property. Displaced 90-day homeowner occupants must purchase and occupy a decent,safe and sanitary replacement dwelling within 1 year after the later of: a) the date of final payment for the displaced dwelling (forcondemnation, use the date just compensation deposited in court) or b) the date a comparable replacement dwelling is made available bythe agency (see 24.204).

3. Unit That YouMoved From

4. Unit That YouMoved To

1. Your Name(s) (You are the Claimant(s)) and present Mailing Address 1a. Your Telephone Number(s)

5. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.


RESIDENTIAL HOUSEHOLDS(1) Individual. (2) Family.

I certify that I am: (check one) I certify that there are ______ persons in my household and that_____ a citizen or national of the United States ______ are citizens or nationals of the United States and _____ are aliens lawfully_____ an alien lawfully present in the United States. present in the United States.

(Form has been revised. See last page)

Appendix 043 - Claim for Replacement Housing- Homeowner (90 Day)

form HUD-40057 (06/2016)Page 2 of 3

Previous editions are obsolete

7. Incidental Expenses in Connection With Purchase of Replacement Dwelling (24.401 (e))Instructions: Enter expenses incidental to the purchase of your new home. Do not includeprepaid costs such as real estate taxes. Attach a copy of the closing statement and other receipts.

* Not to exceed the costs for a comparable replacement dwelling.

8. Mortgage Buydown Payment and Other Debt Service Costs (24.401(d))Instructions: You are entitled to compensation to cover the additional costs you must pay to finance the purchase of a replacement dwelling. The "buydown" paymentcovers those costs that result because the interest rate you must pay for a new mortgage is higher than the interest rate on your old mortgage. The maximum buydownpayment for which you can qualify is the amount needed to reduce your new mortgage balance to the amount which can be amortized with the same periodic payments forprincipal and interest as those for your old mortgage. (The Agency is required to advise you of its estimate of the maximum buydown payment and the interest rate, termand amount on which it was computed. You will need to borrow that amount over that term to qualify for the full payment.) If you have more that one mortgage on eitheryour old or new home, complete a separate Item 8(13) for each computation and include the total amount of all such computations on line 6(7). Note: A mortgage on yourold home that was in effect for less than 180 days before the Agency's initial written offer of just compensation for the property cannot be used as a basis for payment.Also, if the combination of interest and points for the new mortgage exceeds the current prevailing fixed interest rate and points for conventional mortgages and there isno justification for the excessive rate, then the current prevailing fixed interest rate and points shall be used in the computations.

(a) (b)Claimant For Agency

Use Only(1) Legal, closing and related costs, including title search, preparing conveyance

instruments, notary fees, preparing surveys and plats, and recording fees

(2) Lender, FHA or VA Application and Appraisal Fees

(3) Loan Origination or Assumption Fees (Not Prepaid Interest).

(4) Professional Home Inspection, Certification of Structural Soundness, and Termite

Inspection

(5) Credit Report

(6) Owner's and mortgagee's evidence of title, e.g. title insurance *

(7) Escrow Agent's Fee

(8) State Revenue or Documentary Stamps, Sales or Transfer Taxes *

(9) Other Costs (specify)

(10) Total Incidental Expenses (Add lines 7(1) through 7(9).Enter this amount on line 6(6)).

$ $$ $$ $

$ $$ $$ $$ $$ $$ $

% %

(a) (b) (c)Old Mortgage New Mortgage Lesser of Col. (a) or (b)

(1) Outstanding principal balance

(2) Annual interest rate of mortgage

(3) Number of monthly payments remaining on mortgage

$ $

Mos. Mos. Mos.

Part A - Information from Mortgage Documents

(4) Monthly payment required to amortize a loan of $1,000 in __________ months (8(3)(c))

at an annual interest rate of ________ % (8(2)(b))

(5) Monthly payment required to amortize a loan of $1,000 in __________ months (8(3)(c))

at an annual interest rate of ________ % (8(2)(a))

(6) Subtract line 8(5) from line 8(4)

(7) Divide line 8(6) by line 8(4) (carry to 6 decimal places)

(8) Enter old mortgage balance (amount on line 8(1)(a))

(9) Multiply line 8(7) by line 8(8)

(10) New loan needed (subtract 8(9) from 8(8))

Note: If 8(10) is less than 8(1)(b), enter amount from line 8(9) onto line 8(13) and skip lines 8(11) and 8(12)

(11) Divide 8(1)(b) by 8(10) (carry to 6 decimal places)

(12) Multiply line 8(11) by line 8(9)

(13) Enter amount from 8(9) or 8(12), as appropriate(This is the mortgage buydown payment)

(14) Other debt service costs (Reimbursement of purchaser's points and loan origination fees is basedon the new loan needed (8(10)), or the actual new loan balance (8(1)(b)), whichever is less. Do notinclude seller's points or any cost included as an incidental expense in 7(12).)

(15) Add lines 8(13) and 8(14). Enter this amount on 6(7).

Part B - Computation of Payment (Use mortgage amortization table with 6 decimal places.)

$ $

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

9. Certification By Claimant(s): I certify that the information on this claim form and supporting documentation is true and complete and that I have notbeen paid for these expenses by any other source. Signature(s) of Claimant(s) & Date

X

$

$

$

$

$

$$

$

$

$

$

$

form HUD-40057 (06/2016)Page 3 of 3Previous editions are obsolete

Remarks

13. Recommended

14. Approved

$

$

Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy)

To Be Completed by Agency10.Effective Date of Eligibility 11.Date of Referral to Comparable 12. Date Replacement Dwelling

for Relocation Assistance Replacement Dwelling Inspected and Found Decent,(mm/dd/yyyy) (mm/dd/yyyy) Safe and Sanitary (mm/dd/yyyy)

Public reporting burden for this collection of information is estimated to average 1.0 hour per response. This includes the time for collecting, reviewing,and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition PoliciesAct of 1970, and implementing regulations at 49 CFR Part 24 and will be used for determining whether you are eligible to receive a replacement housingpayment for a 90-day homeowner and the amount of any payment. Response to this request for information is required in order to receive the benefits tobe derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB controlnumber.

Privacy Act Notice: This information is being used by an agency administering program services on behalf of HUD for certain HUD programs to determinewhether you are eligible to receive a replacement housing payment for a 90day homeowner and the amount of any payment. Periodically, HUD reviews a random sample of the agency files to ensure compliance with statutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses, or it may take longer to pay you.This information is being collected under the authority of the Housing and Community Development Act of 1987, 42 U.S. C. 3543, the U.S. Housing Act of 1937, as amended, 42 U.S.C., et.seq., and the Housing and Community Development Act of 1981, P.L. 9735, 85 Stat., 34, 408. This information may be shared with Federal agencies and other agencies approved by HUD to administer or assist with services for Uniform Relocation Assistance and Real Property Acquisition obligations.

(NOTE: Updated to incorporate MAP21 statutory changes to the URA effective on 10/01/2014. Please note the current URA regulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP21 changes. For additional information on MAP21 changes to the URA for HUD programs and projects, refer to HUD Notice CPD1409 at the following website:http://portal.hud.gov/hudportal/documents/huddoc?id=1409cpdn.pdf.)



1a. Your Name(s) (You are the Claimant(s)) and Present Mailing Address 1b. Telephone Number(s)

3. Unit That You Moved From

4. Unit That You Moved To

When Did You When Did You Move When Did You MoveDwelling Address Rent/Buy This Unit? To This Unit? Out of This Unit?

Claim for Rental Assistance orDown Payment Assistance(49 CFR 24.402 and 24.401(f))


OMB Approval No. 2506-0016 (exp. 04/30/2018)

2a. Have all members of the household moved to the same dwelling? Yes No (If “No”, list the names of all members and the addresses

to which they moved in the Remarks Section.)

See page 3 for Public Reporting Burden andPrivacy Act Statements before completing this form

2b. Do you (or will you) receive a Federal, State, or local housing program

subsidy at the dwelling you moved to? Yes No

Household Income

Claimant For Agency Use Only(a) (b)

(1) Total number of persons in the household (See item 5(1) or (2))

(2) Annual Gross House-hold Income. (49 CFR24.2(a)(14)). Entername of each house-hold member withincome (include theincome of persons notlawfully present in theU.S.)

(3) Total Gross Annual Income (Sum of entries in item 6(2)) $ $

(4) URA low income limit for number of persons in item 6(1). If item 6(3) is greater than

item 6(4) - Family is not low-income. See 49 CFR 24.402 (b)(2)(ii) $

(5) Gross Monthly Income (Divide item 6(3) by 12) $ $

(6) 30% of item 6(5) or "NA". (If gross annual income item 6(3) is greater than URA low income $ $limit in item 6(4), enter "NA".)

$ $

Instructions: This claim form is for the use of families and individuals applying for rental or down payment assistance under the Uniform RelocationAssistance and Real Property Acquisition Policies Act of 1970 (URA) and may also be used by a 90-day homeowner-occupant who chooses to rentrather than buy a replacement home. The Agency will help you complete the form. HUD also provides information on these requirements and otherguidance materials on its website at www.hud.gov/relocation. If the full amount of your claim is not approved, the Agency will provide you with a writtenexplanation of the reason. If you are not satisfied with the Agency's determination, you may appeal that determination. The Agency will explain how tomake an appeal.Displaced persons must rent/purchase and occupy a decent, safe and sanitary replacement dwelling within one year from the date ofdisplacement for replacement housing payment eligibility (see 24.402(a)(2)). All claims for payments must be filed no later than 18 monthsfrom the date of displacement (see 24.207(d)).

5. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.




6. Determination of Person’s Financial Means (Not applicable to 90-day homeowner-occupantswho choose to rent. Enter NA in Item 6(6).)


Appendix 044 - Claim for Replacement Housing- Renter


(2)

(3)

(4)

(5)

(6) Gross Monthly Rent and Utility Costs $ $ $ $ $(add item 7(1) through (5))

(7) Monthly Housing Subsidy, if applicable $ $ $ $ $(e.g., Housing Choice Voucher/Section 8, other)

Monthly Cost

Unit That You Moved From Unit That You Moved To Comparable(For Homeowner-Occupant, rent (Do not complete if claim is for Replacementwill be determined by the agency.) down payment assistance.) Dwelling

(a) (b) (c) (d) (e)Claimant For Agency Claimant For Agency To Be Provided

Use Only Use Only By Agency(1) Rent (The monthly rental amount due under the terms $ $ $ $ $

and conditions of occupancy. If utilities are not includedin rent, list in item 7(2) to (5))

(8) Net Monthly Rent and Utility Costs $ $ $ $ $(subtract item 7(7) from item 7(6)) (Enter theseamounts on the appropriate lines in Item 8.)

7. Determination of Rent and Average Monthly Utility Costs (See 49 CFR 24.402(b))Instructions: To compute the payment, entries on line (8) must reflect all utility services. Therefore, identify on lines (2) through (5) each utility necessary to provide electricity,gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is not covered by the monthly rent, indicate the estimated out-of-pocket monthly cost.In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). Determine the estimated average monthly cost of a utility service by dividingthe reasonable estimated yearly cost by 12. If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amounton line (7).

8. Computation of Payment: If you are filing for down payment assistance, check this box and skip item 8(1).To Be Completed

By Claimant For Agency Use Only(a) (b)

(1) Monthly Rent and Average Monthly Utility Costs for Unit That You Moved To(From item 7(8), Column (c)) $ $

(2) Monthly Rent and Average Monthly Utility Costs for Comparable Replacement Dwelling(From item 7(8), Column (e)) (To be provided by the Agency)

(3) Lesser of item 8(1) or (2) (If claim is for down payment assistance, enter amount fromitem 8(2))

(4) Monthly Rent and Average Monthly Utility Costs for Unit That You Moved From (From item 7(8), Column (a))(For Homeowner-Occupants who choose to rent, to be determined by the agency.)

(5) 30% of Average Gross Monthly Household Income (From item 6(6), Column (a)). If item 6(6) is "NA", enter"NA" here.

(6) Lesser of item 8(4) or 8(5)

(7) Monthly Need (Subtract item 8(6) from item 8(3))

(8) Amount of Payment Claim (Amount on item 8(7) multiplied by 42) (For a Homeowner-Occupant who elects torent, this amount cannot exceed the difference between the aquisition cost of the displacement dwelling andthe cost of a comparable replacement dwelling. See form HUD-40057, item 5(5).) $ $

(9) Amount Previously Received (if any)

(10) Amount Requested (Subtract item 8(9) from 8(8)) $ $

9. Certification By Claimant(s): I certify that the information on this claim form and supporting documentation is true and complete and that I have not beenpaid for these expenses by any other source.

Signature(s) of Claimant(s) & Date

X


form HUD-40058 (06/2016)Page 3 of 3

Remarks continued on a separate page? Yes No

14. Recommended $

15. Approved $


10. Effective date (mm/dd/yyyy) 11. Date (mm/dd/yyyy) replacement 12. Date(mm/dd/yyyy)of eligibility for relocation dwelling inspected and found person occupied replacementassistance decent, safe and sanitary dwelling

To be Completedby the Agency

Remarks

13. Payment To Be Made In: Lump Sum Monthly Installments Other Installments

(only for down payment assistance) (specify in the Remarks Section)

(NOTE: Updated to incorporate MAP21 statutory changes to the URA effective on 10/01/2014. Please note the current URA regulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP21 changes. For additional information on MAP21 changes to the URA for HUD programs and projects, refer to HUD Notice CPD1409 at the following website: http://portal.hud.gov/hudportal/documents/huddoc?id=1409pdn.pdf.)

of 4 Form HUD-40030 (06/2016)

Claim for Temporary Relocation U.S. Department of Housing and Urban Development OMB Approval No. 2506-0016

Expenses (Residential Moves) Office of Community Planning and Development (exp. 4/30/2018)

(Appendix A, 49 CFR 24.2(a)(9)(ii)(D)) See page 3 for Public Reporting Burden and Privacy Act Statements before completing this form For Agency Name of Agency Use Only

Project Name or Number Case Number

Instructions: This claim form is for the use of families and individuals applying for reimbursement of temporary relocation expenses. The Agency will assist you in completing the form. If the full amount of your claim is not approved, the Agency will provide you with a written explanation of the reason. If you are not satisfied with the Agency’s determination, you may appeal that determination. The Agency will explain how to make an appeal. The Department of Housing and Urban Development provides information on these requirements and other guidance materials on its website at www.hud.gov/relocation. 1a. Your Name(s) (You are the Claimant(s)) and Present Mailing Address 1b. Telephone Number(s)

2a. Have all members of the household moved to the same dwelling? □ Yes □ No (If “No,” list the names of all members and the addresses

to which they moved in the Remarks Section.)

2b. Do you (or will you) receive a Federal, State, or local housing program subsidy at the dwelling you moved to?

□ Yes □ No Dwelling Address When Did You

Rent This Unit? When Did You Move to This Unit?

When Did You Move Out of This Unit?

3. Unit That You Moved From4. Unit That You Moved To 5. Unit That You Returned To 6. CERTIFICATION OF LEGAL RESIDENCY IN THE UNITED STATES (Please read instructions below before completing this section.)Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real Property AcquisitionPolicies Act of 1970, you must be a United States citizen or national, or an alien lawfully present in the United States. The certification below must be completed in order to receive any relocation assistance. (This certification may not have any standing with regard to applicable State laws providing relocation assistance.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) and (h) for hardship exceptions.

Please address only the category (individual or family) that describes your occupancy status. For Line (2), please fill in the correct number of persons.

RESIDENTIAL HOUSEHOLDS (1) Individual. (2) Family.

I certify that I am: (check one) I certify that there are _____ persons in my household and that ______ are _____ a citizen or national of the United States citizens or nationals of the United States and _____ are aliens lawfully _____ an alien lawfully present in the United States present in the United States.

7. DETERMINATION OF MOVING EXPENSES – MOVE TO TEMPORARY UNITInstructions: You may be eligible for reimbursement of actual and reasonable moving costs and related expenses in connection with your move to a temporary housing unit. The computation table below provides you with the ability to compute your payment.

Move to Temporary Unit

(1) Commercial Move

(Actual Costs)

Claimant Agency Use

(2) Self Move

(Actual Costs) (Not to exceed cost paid by a

commercial mover) Claimant Agency Use

(a) Moving Cost Expenses (49 CFR 24.301(g)(1-7)); see page 3 (Do not include storage costs listed separately below.) $ $ $ $

(b) Storage cost (not to exceed 12 months) $ $ $ $ (c) Telephone re-connection $ $ $ $ (d) Cable/Internet re-connection $ $ $ $ (e) Other (Explain in Remarks Section) $ $ $ $ (f) Total (Lines 7(a) – 7(e)) $ $ $ $ (g) Amount Previously Received, if any $ $ $ $ (h) Amount Requested (Subtract Line 7(g) from Line 7(f) $ $ $ $ (i) Total Amount Approved by Agency (for move to temporary unit) $ $

TO BE COMPLETED BY AGENCY SUMMARY FOR MOVE TO TEMPORARY HOUSING UNIT Line No.: Amount Claimed: Amount Recommended: Date Paid: Payable To: (j) Line 7(i), Column (1) $ $ (k) Line 7(i), Column (2) $ $ (l) Total: $ $ Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy) (m) RECOMMENDED $ (n) APPROVED $ Remarks (Attach additional sheets, if necessary)

Appendix 045 - Claim for Temporary Relocation Expenses

of 4 Form HUD-40030 (06/2016

8. DETERMINATION OF MOVING EXPENSES – MOVE TO PERMANENT UNIT Instructions: You may be eligible for reimbursement of actual and reasonable moving costs and related expenses in connection with your move to a permanent housing unit. The computation table below provides you with the ability to compute your payment.

Move to Permanent Unit

(1) Commercial Move

(Actual Costs)

Claimant Agency Use

(2) Self Move

(Actual Costs) (Not to exceed cost paid by a commercial

mover) Claimant Agency Use

(a) Moving Cost Expenses (49 CFR 24.301(g)(1-7)); see page 3 $ $ $ $ (b) Telephone re-connection $ $ $ $ (c) Cable/Internet re-connection $ $ $ $ (d) Other (Explain in Remarks Section) $ $ $ $ (e) Total (Lines 8(a) – 8(d)) $ $ $ $ (f) Amount Previously Received, if any $ $ $ $ (g) Amount Requested (Subtract Line 8(f) from Line 8(e) $ $ $ $ (h) Total Amount Approved by Agency (for move to permanent unit) $ $

TO BE COMPLETED BY AGENCY SUMMARY FOR MOVE TO PERMANENT UNIT Line No.: Amount Claimed: Amount Recommended: Date Paid: Payable To: (i) Line 8(h), Column (1) $ $ (j) Line 8(h), Column (2) $ $ (k) Total: $ $ Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy) (l) RECOMMENDED $ $ (m) APPROVED $ $ Remarks (Attach additional sheets, if necessary) 9. MONTHLY OUT-OF-POCKET COSTS FOR TEMPORARY RELOCATION Costs listed on this form are for the period beginning ____________ _______ and ending _____________ ________ TOTAL # OF MONTHS: _____ (Month/Day) (Year) (Month/Day) (Year) DETERMINATION OF RENT AND AVERAGE MONTHLY UTILITY COSTS Instructions: To compute the payment, entries on Line 9(i) must reflect all utility services. Therefore, identify on Lines 9(b) through 9(f) each utility necessary to provide electricity, gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amount on Line 9(h). Monthly Temporary Relocation Cost (For temporary relocation that lasts more than one month, either complete a Continuation Form for each additional month of temporary relocation or enter total claimed on Line 9(p) and explain under “Remarks.”

Unit You Moved From

Unit You Moved To

Increase In Monthly Cost

Amount Approved

(1) Claimant

(2) For Agency Use Only

(3) Claimant



(6) To Be Provided by

Agency

(a) Rent (The monthly rental amount due under the terms and conditions of occupancy). Check appropriate box: □ All utilities included □ Utilities not included (list on Line 9(b) to 9(f) below)

$

$

$

$

$

$

(b) Electricity $ $ $ $ $ $ (c) Gas $ $ $ $ $ $ (d) Water/sewer $ $ $ $ $ $ (e) Sanitation $ $ $ $ $ $ (f) Other $ $ $ $ $ $ (g) Gross Monthly Rent and Utility Costs (add Lines 9(a) through 9(f))

$

$

$

$

$

$

(h) Monthly Housing Subsidy, if applicable (e.g., Housing Choice Voucher/Section 8, other)

$

$

$

$

$

$

(i) Net Monthly Rent and Utility Costs for Month of ________ (subtract Line 9(h) from Line 9(g) above)

$

$

$

$

$

$

OTHER REASONABLE OUT-OF-POCKET EXPENSES Instructions: You may be eligible for other reasonable out-of-pocket expenses as approved by the agency in connection with your temporary move. Monthly Cost For Month of: ____________________ _______ (Month) (Year)

(1) Claimant

(2) Agency Use

(j) Per Diem for unit without cooking facilities: $__________ per adult x ______ days in this month period $__________ per child under age 12 x ______ days in this month period

$

$

Other (e.g., increased transportation costs, boarding for pets, parking). Itemize. (k) $ $ (l) $ $ (m) $ $

of 4 Form HUD-40030 (06/2016)

(n) Total (add lines 9(j) through 9(m)) $ $

TO BE COMPLETED BY AGENCY SUMMARY OF MONTHLY OUT-OF-POCKET COSTS FOR TEMPORARY RELOCATION Line No.: Amount Claimed: Amount Recommended: (o) Add Lines 9(i) Column

6 and Line 9(n) Column 2 $ $

(p) Multiply Line 9(o) by number of months of temporary relocation (# of months: ______) or enter total amount

from all Continuation Sheets, Lines 10(i) Column 6 and 10(n) Column 2 $ $


(r) RECOMMENDED $

(s)APPROVED $ Remarks (Attach additional sheets, if necessary)

CERTIFICATION BY CLAIMANT(S): I certify that this claim and supporting information are true and complete and that I have not been paid for these expenses by any other source. I ask that the amounts on Line 7(n), Line 8(m) and Line 9(r), be paid to: □ me □ the contractor(s) (as specified in the Remarks Section). Signature(s) of Claimant(s): _________________________________________________________________________________ Date: _______________________ Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Eligible Actual Residential Moving Expenses (49 CFR 24.301(g)(1-7)) 1) Transportation of the displaced person and personal property. Transportation costs for a distance beyond 50 miles are not eligible, unless the Agency

determines that relocation beyond 50 miles is justified. 2) Packing, crating, unpacking and uncrating of the personal property.3) Disconnecting, dismantling, removing, reassembling and reinstalling relocated household appliances and other personal property.4) Storage of the personal property for a period not to exceed 12 months, unless the Agency determines that a longer period is necessary.5) Insurance for the replacement value of the property in connection with the move and necessary storage.6) The replacement value of property lost, stolen, or damaged in the process of moving (not through the fault or negligence of the displaced person, his or her

agent, or employee) where insurance covering such loss, theft, or damage is not reasonably available.7) Other moving-related expenses that are not listed as ineligible under §24.301(h), as the Agency determines to be reasonable and necessary.

Public reporting burden for this collection of information is estimated to average 30 minutes per response. This includes the time for collecting, reviewing and reporting the data. The information is being collected under the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S. Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., and the Housing and Community Development Act of 1981, P.L. 97-35, 85 stat., 34, 408 to determine if you are eligible to receive a payment for temporary moving expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a valid OMB control number.

Privacy Act Notice: This information is being used by an agency administering program services on behalf of HUD for certain HUD programs to determine whetheryou are eligible to receive a payment for temporary moving expenses. Periodically, HUD reviews a random sample of the agency files to ensure compliance withstatutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it,you may not receive any payment for these expenses or it may take longer to pay you. This information is being collected under the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S. Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., and the Housing and Community Development Act of 1981, P.L. 9735, 85 stat., 34, 408. This information may be shared with Federal agencies and other agencies approved by HUD to administer or assist with servicesfor Uniform Relocation Assistance and Real Property Acquisition Policies Act obligations.

of 4 Form HUD-40030 (06/2016)

[CONTINUATION SHEET] Claim for Temporary Relocation U.S. Department of Housing and Urban Development

Expenses (Residential Moves) Office of Community Planning and Development

(Appendix A, 49 CFR 24.2(a)(9)(ii)(D)) 10. CONTINUATION SHEET FOR EACH ADDITIONAL MONTH OF TEMPORARY RELOCATION

Costs listed on this form are for the period beginning ______________ _______ and ending ____________ ________ TOTAL # OF MONTHS: ______ (Month/Day) (Year) (Month/Day) (Year)

DETERMINATION OF RENT AND AVERAGE MONTHLY UTILITY COSTS Instructions: To compute the payment, entries on Line (i) must reflect all utility services. Therefore, identify on Lines 10(b) through 10 (f) each utility necessary to provide electricity, gas, other heating/cooking fuels, water and sewer. In those cases where the utility service is covered by the monthly rent, enter “IMR” (In Monthly Rent). If a monthly housing program subsidy (e.g., Housing Choice Voucher/Section 8, other) has been provided, enter the applicable amount on Line 10(h). Temporary Relocation Cost for Periods That Exceed One Month (For temporary relocation that lasts more than one month, complete this Continuation Form for each additional month of temporary relocation.

Unit You Moved From

Unit You Moved To

Increase In Monthly Cost

Amount Approved

(1) Claimant


(3) Claimant



(6) To Be Provided by

Agency (a) Rent (The monthly rental amount due under the

terms and conditions of occupancy).Check appropriate box: □ All utilities included □ Utilities not included (list on Lines 10 (b) to

10(f) below) $ $ $ $ $ $ (b) Electricity $ $ $ $ $ $ (c) Gas $ $ $ $ $ $ (d) Water/sewer $ $ $ $ $ $ (e) Sanitation $ $ $ $ $ $ (f) Other $ $ $ $ $ $ (g) Gross Monthly Rent and Utility

Costs (add Lines 10(a) through 10(f)) $ $ $ $ $ $ (h) Monthly Housing Subsidy, if

applicable (e.g., Housing Choice Voucher/Section 8, other) $ $ $ $ $ $

(i) Net Monthly Rent and Utility Costs for Month of ________ (subtract Line 20(h) from Line 10(g)above) $ $ $ $ $ $

OTHER REASONABLE OUT-OF-POCKET EXPENSES Instructions: You may be eligible for other reasonable out-of-pocket expenses as approved by the agency in connection with your temporary move. Monthly Cost For Month of: ______________________ _______

(Month) (Year) (1)

Claimant (2)

Agency Use (j) Per Diem for unit without cooking facilities:$__________ per adult x ______ days in this month period $__________ per child under age 12 x ______ days in this month period $ $

Other (e.g., increased transportation costs, boarding for pets, parking). Itemize. (k) (l) $ $ (m) $ $ (n) Total (add lines 10(j) through 10(m)) $ $

Appendix 046 - Temporary Relocation Notice

On-Site

Temporary Relocation Notice __ (date)________ Mr. John Doe Grant Apartments 245 N. Washington Street Apartment (XXX) Trenton, NJ 08551 Dear (Resident) :

In the Notice of Nondisplacement we sent you on (insert date Notice of Nondisplacement was issued), we indicated that you may be required to move from your current unit in order for the necessary rehabilitation to be completed. Based on requirements and schedule provided by the contractor and the property management, you will need to vacate your unit to allow for renovations. The estimated time you will need to temporarily move from your unit is for a 6 to 8 week period. We recognize this may present some degree of inconvenience, your household will be moved to a vacant unit in another section of the building. This move will require you to move to another unit temporarily while your units is being renovated. Once the renovations are complete, you will need to move back to your original unit. This notice is to inform you that you will be required to temporarily relocate from you current unit on or about (insert date). The conditions of your temporary housing are as follows:

1. The management of Grant Apartments will provide you 15 advance written notice before you will be required to temporarily move to another unit in the building.

2. The property owner will take care of all arrangements and pay for any costs

associated with the temporary move.

A property management representative will be available to provide any assistance during the time of your local area hotel stay and update you on the status of the property’s rehabilitation. In the interim, f you have any questions or concerns about the temporary relocation process, please contact: (name) , (title) , at (phone) . Please keep this notice in your files. Phone # for the Hearing Impaired _____________________ Sincerely,

(name) (title)


On-Site Transfer


In the Notice of Nondisplacement we sent you on (insert date Notice of Nondisplacement was issued), we indicated that you may be required to move from your current unit in order for the necessary rehabilitation to be completed. Based on requirements and schedule provided by the contractor and the property management, you will need to permanently move from your unit to a newly renovated apartment one time. We recognize this may present some degree of inconvenience, however, you will only need to move once. This notice is to inform you that you will be required to transfer from you current unit to unit #_______on or about (insert date). The conditions of your temporary housing are as follows:

1. The management of Grant Apartments will provide you 15 advance written notice before you will be required to transfer to an another unit in the building.

2. The property owner will take care of all arrangements and pay for any costs

associated with the transfer. A property management representative will be available to provide any assistance during the time of your local area hotel stay and update you on the status of the property’s rehabilitation.

In the interim, f you have any questions or concerns about the temporary relocation process, please contact: (name) , (title) , at (phone) . Please keep this notice in your files. Phone # for the Hearing Impaired _____________________ Sincerely,

(name) (title)


Off-Site Hotel


In the Notice of Nondisplacement we sent you on (insert date Notice of Nondisplacement was issued), we indicated that you may be required to move from your current unit in order for the necessary rehabilitation to be completed. Unfortunately, based on requirements and schedule provided by the contractor and the property management, you will need to vacate your unit to allow for renovation. The estimated time that your household will need to temporarily move from your unit for a 6 to 8 week period. We recognize this may present some degree of inconvenience, however to ensure that you and your family have reasonable, off site accommodations, arrangements have been made on your behalf at a local hotel in the immediate area. This notice is to inform you that you will be required to temporarily relocate to a local area hotel on or about (insert date). The conditions of your temporary housing are as follows:

1. The management of Grant Apartments will provide you 15 advance written notice before you will be required to temporarily move to the local area hotel.

2. The property owner will take care of all arrangements and pay for the cost of

the short term hotel stay.

3. A “storage pod” will be made available to you at no cost to store your personal possessions and furniture during the time of your short term stay at the local area hotel. Assistance to with packing and unpacking of your personal belongs will be provided upon request.

A property management representative will be available to provide any assistance during the time of your local area hotel stay and update you on the status of the property’s rehabilitation. In the interim, f you have any questions or concerns about the temporary relocation process, please contact: (name) , (title) , at (phone) . Please keep this notice in your files. Phone # for the Hearing Impaired _____________________ Sincerely,

(name) (title)


[01/06] App. 29-1

MOVE-IN NOTICE (GUIDEFORM NOTICE TO PROSPECTIVE TENANT)

Grantee or Agency Letterhead (date)

Dear :

On (date) , (property owner) submitted an application to the (Grantee) for financial assistance under a program funded by the Department of Housing and Urban Development (HUD). The proposed project involves [acquisition] [rehabilitation] [demolition] and/or [conversion] of the property located at (address) . Because Federal funds are planned for use in this project, the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (URA) [and/or section 104(d) of the Housing and Community Development Act of 1974, as amended] may apply to persons in occupancy at the time the application was submitted for HUD funding. However, if you choose to occupy this property subsequent to the application for federal financial assistance, as a new tenant you will not be eligible for relocation payments or assistance under the URA [and/or section 104(d)].

This notice is to inform you of the following information before you enter into any lease agreement and/or occupy the property located at the above address:

♦ You may be displaced by the project.♦ You may be required to relocate temporarily.♦ You may be subject to a rent increase.♦ You will not be entitled to any relocation payments or assistance

provided under the URA [and/or section 104(d)]. If you have tomove or your rent is increased as a result of the above project, youwill not be reimbursed for any such rent increase or for any costs orexpenses you incur in connection with a move as a result of theproject.

Please read this notification carefully prior to signing a rental agreement and moving into the project. If you should have any questions about this notice, please contact (Grantee) at (address and telephone number) . Once you have read and have understood this notice, please sign the statement below if you still desire to lease the unit.

Sincerely,

(name and title)

Appendix 047 - Move-In Notice- Residential


[01/06] App. 29-2

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * I have read the above information and understand the conditions under which I am moving into this project.

Print Name of Tenant(s)

Signature(s)

Address and Unit Number

Date

NOTE:

This is a guideform. It should be revised to reflect the project circumstances.

Appendix 048 - Tenant Rent Roll (sample)

Appendix 049 – Relocation Moving Reimbursement NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS

SANDY RECOVERY PROGRAMS RELOCATION MOVING REIMBURSEMENT

In accordance the provisions of the Uniform Relocation Act (URA) pertaining to reimbursement for moving expenses, I select the following option for the property located at:

_______________________________________________________________________

Option #1 – Reimbursement for Actual Moving Expenses ________Yes ______No

Option #2 – Fixed Moving Expense Reimbursement ________Yes ______ No

Option #3 – Combination of both fixed and actual ________ Yes ______ No

(Effective Date: August 24, 2015)

The schedule is based on the “number of rooms of furniture” owned by the displaced household:

• The room count may be increased if the amount of possessions in a single room orspace actually constitutes more than the normal contents of one room of furniture orother personal property;

• If items are stored outside the dwelling unit, an appropriate number of rooms may beadded

____________________________ ________________ Printed Name Project File No#

_____________________________ ________________ Signature Date

Occupant Owns Furniture Occupant Does Not Own Furniture

Number of rooms of furniture 1

room 2

rooms 3

rooms 4

rooms 5

rooms 6

rooms 7

rooms 8

rooms Addt’l room

1 room/ no furniture

Addt’l room/no furniture

650 750 850 1000 1150 1300 1400 1600 200 200 50

Previous versions obsolete.

3. Unit That YouMoved From

4. Unit That YouMoved To

Residential Claim for Movingand Related Expenses(49 CFR 24.301 and 24.302)


1. Your Name(s) (You are the Claimant(s)) and Present Mailing Address 1a. Telephone Number(s)

2. Have All Members of the Household Moved to the Same Dwelling? Yes No(If “No,” list the names of all members and the addresses to which they moved in the Remarks Section.)

Number of Rooms Date DateDwelling Address (include Apartment No.) of Furniture? * Occupied Vacated



See page 3 for Public Reporting Burden andPrivacy Act Statements before completing this form

Instructions: This claim form is for the use of families and individuals applying for payment of residential moving and related expenses under the Uniform Relocation Assistanceand Real Property Acquisition Policies Act of 1970 (URA). You may be eligible to apply for either (1) a fixed payment (see 24.302), or (2) payment for actual reasonable movingcosts and related expenses (see 24.301), or (3) in some cases, a payment based on a combination of moving options (contact Agency). All claims for actual expenses mustbe supported by receipts or other acceptable evidence. The Agency will explain the differences between the types of moving options and will help you complete this form. HUDprovides information on these requirements and other guidance materials on its website at www.hud.gov/relocation. If the full amount of your claim is not approved, the Agencywill provide you with a written explanation of the reason. If you are not satisfied with the Agency's determination, you may appeal that determination. The Agency will explainhow to make an appeal. All claims for payments must be filed no later than 18 months from the date of displacement (see 24.207(d)).

5. Is This a Final Claim? Yes No

7a. Commercial Move 7b. Self Move 7c. Self Move

(Actual Costs) (Actual Costs) (Fixed Schedule)(Based on lower of 2 bids) (Not to exceed cost of (See 49 CFR 24.302)

commerical move)Claimant Agency Use Claimant Agency Use Claimant Agency Use

7. Computation of Payment (See 49 CFR 24.301 and 24.302)Instructions: You may be eligible to apply for either (1) a fixed payment (see 24.302), or (2) payment for actual and reasonable moving costs and related expenses(see 24.301), or (3) in some cases, a payment based on a combination of moving options (see 24.301(b)). The computation table in this section provides you withthe ability to compute your payment based on one or a combination of moving options depending on your eligibility and your needs and desires.

A fixed payment is used to compute a payment based on the numbers of rooms of furniture within the displacement dwelling. The Residential Fixed Moving Cost Scheduleavailable at www.hud.gov/relocation, will provide the payment amount for the state in which the displacement occurred. (Note: for persons occupying a dormitory styleroom or where the move is performed by the Agency at no cost to the displaced person, the payment amount is limited to the amount specified for such moves on theFixed Moving Cost Schedule.) If you choose to claim a fixed payment, fill in the applicable schedule amount in column 7c Line (3). In some cases, persons who plansto claim only a fixed payment may also be eligible for additional moving options to move personal property located outside the dwelling and not considered in the FixedMoving Cost Schedule (jungle gym, hot tub, etc.) or for personal property requiring specialized moving assistance within the dwelling (piano, pool table, medical equipment,etc.). In these situations you may also be eligible for a payment based on actual costs for a commerical move and/or self move for these items. Contact the Agencyfor further assistance. If the Agency determines you are eligible for other moving options in addition to the fixed payment, fill in all applicable claim information requestedfor the type(s) of moving option specified in the table.

(1) Moving Cost Expenses (49 CFR 24.301(g)(1-7); see page 3)(Do not include storage costs listed separately below). [ForMobile Home Owner Occupants also include 24.301(g)(8-10),if applicable.](2) Storage Cost (Requires prior agency approval) (Not toexceed 12 months)(3) Fixed Moving Cost Schedule Amount (Based on number ofrooms of furniture in Item 3). For amount see Moving CostSchedule available at www.hud.gov/relocation.(4) Other (Explain in Remarks Section)(5) Total Amount of Claim.(6) Amount Previously Received, if any.(7) Amount Requested (Subtract line (6) from line (5)(8) Total Amount Requested - Combination Moves Only(add applicable columns 7(a)(7), 7(b)(7) and 7(c)(7))

6. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)

Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.




* Excluding bathrooms,hallways and closets.

Page 1 of 3 HUD form 40054 (06/2016)

Appendix 050- Claim for Moving Expenses- Residential

Previous versions obsolete.

Remarks (Attach additional sheets, if necessary)

Additional sheets attached? Yes No

9. Recommended $

10. Approved $

Payment Action Amount of Payment Signature Name (Type or Print) Date (mm/dd/yyyy)To Be Completed by the Agency


8. Certification By Claimant(s): I certify that this claim and supporting information are true and complete and that I have not been paidfor these expenses by any other source. I ask that the amount on line (7) of Item 7 or line (8) of Item 7 for combination moves bepaid to me the contractor(s) (as specified in the Remarks Section).

Signature(s) of Claimant(s) & Date:

X

Page 2 of 3 HUD form 40054 (06/2016)

Eligible Actual Residential Moving Expenses (49 CFR 24.301(g)(1-10)(1) Transportation of the displaced person and personal property. Transportation costs for a distance beyond 50 miles are not eligible, unless the

Agency determines that relocation beyond 50 miles is justified.(2) Packing, crating, unpacking, and uncrating of the personal property.(3) Disconnecting, dismantling, removing, reassembling, and reinstalling relocated household appliances and other personal property. For businesses,

farms or nonprofit organizations this includes machinery, equipment, substitute personal property, and connections to utilities available withinthe building; it also includes modifications to the personal property, including those mandated by Federal, State or local law, code or ordinance,necessary to adapt it to the replacement structure, the replacement site, or the utilities at the replacement site, and modifications necessary toadapt the utilities at the replacement site to the personal property.

(4) Storage of the personal property for a period not to exceed l2 months, unless the Agency determines that a longer period is necessary.(5) Insurance for the replacement value of the property in connection with the move and necessary storage.(6) The replacement value of property lost, stolen, or damaged in the process of moving (not through the fault or negligence of the displaced person,

his or her agent, or employee) where insurance covering such loss, theft, or damage is not reasonably available.(7) Other moving-related expenses that are not listed as ineligible under § 24.301(h), as the Agency determines to be reasonable and necessary.(8) The reasonable cost of disassembling, moving, and reassembling any appurtenances attached to a mobile home, such as porches, decks, skirting, and

awnings, which were not acquired, anchoring of the unit, and utility “hookup” charges.(9) The reasonable cost of repairs and/or modifications so that a mobile home can be moved and/or made decent, safe, and sanitary.(10) The cost of a nonrefundable mobile home park entrance fee, to the extent it does not exceed the fee at a comparable mobile home park, if the

person is displaced from a mobile home park or the Agency determines that payment of the fee is necessary to effect relocation.

Public reporting burden for this collection of information is estimated to average 30 minutes per response. This includes the time for collecting, reviewing,and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition PoliciesAct of 1970, and implementing regulations at 49 CFR Part 24 and will be used for determining whether you are eligible to receive a payment for moving andrelated expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. Thisagency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

Privacy Act Notice: This information is being used by an agency administering program services on behalf of HUD for certain HUD programs to determine whether you are eligible to receive a payment for moving and related expenses and the amount of any payment. Periodically, HUD reviews a random sample of theagency files to ensure compliance with statutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses or it may take longer to pay you. This information is being collectedunder the authority of the Housing and Community Development Act of 1987, 42 U.S.C. 3543, the U.S.Housing Act of 1937, as amended, 42 U.S.C. 1437 et seq., andthe Housing and Community Development Act of 1981, P.L. 97-35, 85 stat., 34,408. This information may be shared with Federal agencies and other agenciesapproved by HUD to administer or assist with services forUniform Relocation Assistance and Real Property Acquisition Policies Act obligations.

Page 3 of 3 HUD form 40054 (06/2016)

Appendix 051 - Section 104(d) One-for-One Unit Replacement Plan

One for One Replacement Plan Section 104(d) of the Housing and Community Development

Act of 1974, as amended

City/County/State of _________________

Summary

The (jurisdiction) is submitting this Housing Replacement Plan for (CDBG) or (HOME) assisted activities that will precipitate the need to replace housing available to low and moderate income persons.

HUD regulations at 24 CFR Part 42, Subpart 3 require that a jurisdiction submit (to HUD) information on the demolition, rehabilitation or conversion of housing units that will make a unit unaffordable or unavailable to low and moderate income persons.

Reporting and Disclosure

Before the (jurisdiction) executes a contract for any activity that would create the need for one-for-one replacement, we made this Plan public and are submitting it to HUD for monitoring purposes. The (jurisdiction) made this Plan public by:

____ Newspaper advertisement (notice attached)

____ Public Meeting (notice attached)

____ As minutes from official government hearings (attach minutes), or

____ Other (explain)

Plan for Replacement of Units no Longer Available as Affordable Housing Stock

Description of the activity:

Location on a map and number of units to be demolished/converted:

Schedule for completion of demolition or conversion:

Location on map and number of replacement units:

Source of funding and timing for replacement of units:

Basis for determining replacement units will remain affordable for at least 10 years:

Justification for replacing larger units with smaller units (if applicable):

These charts may be used for submittal to HUD along with other required documentation when the City will be demolishing or converting units that will trigger replacement.

Units demolished/converted

Unit Size 2005 2006 2007 TOTALS

1 bedroom 0 0 0 0

2 bedroom 0 0 0 0

3 bedroom 0 0 0 0

4 bedroom 0 0 0 0

5 bedroom 0 0 0 0

TOTALS

B. TIMING PROVIDED FOR THE REPLACEMENT UNITS:

REPLACEMENT UNIT

TIME-LINE

Unit Size 2004 2005 2006 2007 TOTALS

1 bedroom 0 0 0 0 0

2 bedroom 0 0 0 0 0

3 bedroom 0 0 0 0 0

4 bedroom 0 0 0 0 0

5 bedroom 0 0 0 0 0

TOTALS 0 0 0 0

Replacement units may be provided one year prior to contract for demolition/conversion, and up to three year after.

In the example above, the project demolition contract was in program year 2005.

2

CERTIFICATION UNIFORM RELOCATON ACT (URA)

RELOCATION STAFF – CONFLICT OF INTEREST

I ___________(insert name here)_________________hereby certify that in accordance with the provisions found at 49 CFR 24.4 (Assurances) that:

• Neither my employment nor my compensation for the preparation of URA notices,comparable replacement housing units, temporary housing units, claims for replacementhousing, purchase assistance or reimbursement for moving expenses are in any waycontingent upon the assistance provided to any individual, family, business, non-profit orfarmer;

• That I have no direct or indirect present or contemplated future personal interest in suchproperty or in any benefit from the acquisition of property appraised, identified ascomparable replacement housing or any temporary housing; and

• That I have not revealed the results of any assistance provided under the Uniform Act toanyone other than the officials of the State of New Jersey officials of the U.S.Department of Housing and Urban Development.

Certified as of the ____________ day of ___________________ 20 _______

Signature _________________________________

Date _____________________________________

Certification of Conflict of Interest – URA April 2017

Appendix 052 - Relocation Specialist or Program Staff Certification

form HUD-40055(06/2016)

Previous editions are obsolete Page 1 of 5


OMB Approval No. 2506-0016(exp. 4/30/2018)Claim for Actual

ReasonableMoving and RelatedExpenses -Nonresidential

U.S. Department of Housingand Urban Development

(49 CFR 24 Subpart D)

Section A. General

Instructions: This claim form is for the use of displaced businesses, nonprofit organizations, and farms that wish to claim a payment forActual Reasonable Moving and Related Expenses, including Reestablishment Expenses, rather than claim a Fixed Payment, underthe Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (URA). The Agency will explain the differencebetween the two payments and will help you complete this form. HUD provides information on these requirements and other guidancematerials on its website at www.hud.gov/relocation. If you are eligible for either payment, the Agency will help you to determine which ismost advantageous. If the full amount of your claim is not approved, the Agency will provide you with a written explanation of the reason. Ifyou are not satisfied with the Agency’s determination, you may appeal the determination. The Agency will explain how to make an appeal.All claims for payments must be filed no later than 18 months from the date of displacement (see 24.207(d)).

Attach supplemental pages as necessary. All expenses must be thoroughly identified and be accompanied by receipts or otherappropriate documentation to be eligible for payment. Professional services and other claims for time expended based on salaries,earnings or fees related to 49 CFR 24.301(g)(12), 24.301(g)(17)(iii)-(vi), and 24.303(b), must be actual, reasonable, necessary, and shouldbe preapproved by the Agency.

(Eligible Moving Expenses: See 24.301(g)(1)-(7); 24.301(g)(11)-(18) & 24.303; Ineligible Moving Expenses: See 24.301(h))

(Eligible Reestablishment Expenses: See 24.304(a); Ineligible Reestablishment Expenses: See 24.304(b))

Nonprofit Organization Partnership Nonprofit Organization No (If “No," attach an explanation)

1. Name of Business, Farm or Nonprofit Organization 2. Name, Title, Address and Telephone Number of Claimant or Claimant's

Authorized Agent

3. Address from which Business, Farm or Nonprofit Organization moved

4a. Address to which Business, Farm or Nonprofit Organization moved

5. Type of Operation (Check One) 6. Type of Ownership (Check One) 7. Is this a Final Claim?

Business Farm Operation Sole Proprietorship Corporation Yes

4b. Date Move Started 4c. Date Move Completed

(mm/dd/yyyy) (mm/dd/yyyy)

8. Certification of Legal Residency in the United States (Please read instructions below before completing this section.)

Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and Real PropertyAcquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the United States. The certificationbelow must be completed in order to receive any relocation benefits. (This certification may not have any standing with regard to applicable Statelaws providing relocation benefits.) Please address only the category that describes your citizenship status. For item (2), please fill in the correct numberof partners. The certification for a nonresidential displaced person may be signed by an owner or other person authorized to sign on its behalf.Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.

NONRESIDENTIAL DISPLACEMENTS(1) Sole Proprietorship. (2) Partnership. (3) Corporation. (Name of Corporation)I certify that I am: (check one) I certify that there are ______ partners in the I certify that ___________________________,_____ a citizen or national of the United States partnership and that______ are citizens or is established pursuant to State law and is_____ an alien lawfully present in the United States. nationals of the United States and _____ are authorized to conduct business in the

aliens lawfully present in the United States. United States.


Appendix 053 - Claim for Moving Expenses- Business

form HUD-40055(06/2016)


Section B. Supporting Data for Moving Expenses (Not identified in Sections C, D, E, F or G) (49 CFR 24.301(d) & 24.301(e)) (Attach supplemental pageif additional space is needed and attached receipts for costs incurred.) (Identify if move is commerical move , self move , or combination move ;if combination move, identify each expense as commerical or self move.)

(1) $ $

(2)

(3)

(4)

(5) Total Costs (Include this amount in line (1) of Item 9, Total) $ $

Expense IdentificationAmount Claimed For Agency Use Only

Section C. Supporting Data for Storage Costs (49 CFR 24. 301(g)(4)) Name and Address of Storage Company

Computation of Storage Costs

Item Amount For Agency Use Only

Monthly Rate for Storage $ $

Number of Months in Storage

Total Storage Costs (Include this amount in line (1) of Item 9, Total) $ $

Description of Property Stored (List may be attached)

Is This a Final Claim for Storage? Yes No

Date Moved to Storage Date Moved From Storage

(mm/dd/yyyy) (mm/dd/yyyy)

(1) Searching Time Number of Hours ( ) x Hourly Rate of Earnings ( ) = $ $

(2) Time Spent Obtaining Permits, Attending Zoning Hearings

Number of Hours ( ) x Hourly Rate of Earnings ( ) = $ $

(3) Time Spent Negotiating Purchase/Lease of Replacement Site

Number of Hours ( ) x Hourly Rate of Earnings ( ) = $ $

(4) Transportation (Consult with Agency on allowable rate per mile of personal vehicle) $ $

(5) Lodging (Dates: Attach receipts) $ $

(6) Fees Paid to Real Estate Broker or Agent, (Excluding fees or commissions related to site purchase)

(Attach contract or other evidence) $ $

(7) Cost of Meals $ $

(8) Other Expenses (Specify and attach receipts) $ $

(9) Total Searching Expenses

(Add lines (1) thru (9). Include this amount, or $2,500, whichever is less, in line (1) of Item 9 Total.) $ $

Section D. Supporting Data for Searching Expenses (49 CFR 24.301(g)(17))Amount Claimed For Agency Use Only

Section E. Supporting Data for Payment for Actual Direct Loss of Personal Property (List separately each item for which amount claimed in Column(f) is more than $500. Other Items may be grouped together. The Agency will advise on acceptable method for listing items. Attach additionalsheets, as needed.) (49 CFR 24.301(g)(14))

(a) (b) (c) (d) (e) (f) (g)Identify Personal Property Fair Market Value As Is Proceeds From Value Not Recovered Estimated Cost of Amount Claimed For Agency for Which Payment for For Continued Use At Sale By Sale Moving Old Property (Lesser of Use Only

Actual Direct Loss is Present Location (Column (b) minus As Is (To be entered Column (d) orRequested (Attach appraisals Column (c)) by Agency) (e))

or other evidence) (see 24.301(g)(14)(ii))

$ $ $ $ $ $

(1) Total (Add all entries in column (f) above) $ $

(2) Cost of Effort to Sell Property (e.g., advertising) $ $

(49 CFR 24.301(g)(15))

(3) Total Amount Claimed (Add lines (1) and (2). $ $Include this amount in line (1) of Item 9 Total)

Claimant's Release of Personal PropertyI/We release to the Agency ownership of all personal propertyremaining on the real property.Signature(s) of Claimant(s) or Agent Date (mm/dd/yyyy)

form HUD-40055(06/2016)


Identify Substitute Actual Cost of Proceeds From Net Cost of Estimated Cost of Amount Claimed For Agency Personal Property Substitute Property Sale orTrade-in of Substitute Moving and Reinstalling (Lesser of Use Only for which Payment Delivered and Installed Property That Was Personal Property Replaced Item (To be column (d) is Requested at New Location Replaced (Column (b) minus entered by agency) or (e)) (Attach documentation) Column (c)) (see 24.301(g)(16)(ii))

Section F. Supporting Data for Substitute Personal Property. List separately each item for which amount claimed in column (f) is more than $500.Other items may be grouped together. The agency will advise on acceptable method of listing items. Attach additional sheets, as needed.)(49 CFR 24.301(g)(16))

(a) (b) (c) (d) (e) (f) (g)

$ $ $ $ $ $

(1) Total (Add all entries in column (f) above) $ $

(2) Cost of Effort to Sell Property (e.g., advertising)

(49 CFR 24.301(g)(15)) $ $

(3) Total Amount Claimed (Add lines (1) and (2). $ $Include this amount in line (1) of Item 9 Total)

Claimant's Release Of Personal PropertyI/We release to the Agency ownership of all personalproperty remaining on the real property.

Signature(s) of Claimant(s) or Agent Date (mm/dd/yyyy)

Section G. Supporting Data for Related Nonresidential Expenses (49 CFR 24.303)

Only if applicable and Determined Actual, Reasonable and Necessary. (Attach supplemental page, if needed)

Amount For Agency

Expense Identification Claimed Use Only

(1) Utility Connections from Right-of-Way to Improvements at Replacement Site.

(2) Professional Services for Site Suitability Determination

(Based on Agency pre-approved reasonable hourly rates) Number of Hours ( ) X Hourly Rate of Earnings ($ ) =

(3) Impact Fees or One Time Assessments for Utility Usage.

Total Related Nonresidential Expenses: (Add lines (1) through (3))

(Include this amount in line (1) of Item 9 Total)

(1)

$ $

(2)

(3)

(4)

(5) Total Costs (Enter this amount, or $25,000, whichever is less, on line (2) of Item 9) $ $

Section H. Supporting Data for Reestablishment Expenses. (49 CFR 24.304) (Attach supplemental page if additionalspace is needed.) Amount For Agency Expense Identification Claimed Use Only

form HUD-40055(06/2016)


Section I. Certification By Claimant(s): I certify that the information on this claim form and supporting documentation is true and complete and that Ihave not been paid for these expenses by any other source.

Signature(s) of Claimant(s) or Claimant's Authorized Agent Title (Type or Print) Date

X

To Be Completed by Agency


10. Recommended $

11. Approved $


(1) Moving Expenses (From Section B, C, D, E, F, G) $ $

(2) Reestablishment Expenses (From Section H) $ $

(3) Other (Attach explanation) $ $

(4) Total Amount Claimed (Add lines (1) thru (3)) $ $

(5) Amount Previously Received, if any $ $

(6) Amount Requested (Subtract line (5) from line (4)) $ $

9. Computation of Payment Item Amount For Agency Use Only

Remarks:

Public reporting burden for this collection of information is estimated to average 1.5 hours per response. This includes the time for collecting, reviewing,and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition PoliciesAct of 1970, and implementing regulations at 49 CFR Part 24 and will be used for determining whether you are eligible to receive a payment for moving andrelated expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. Thisagency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

Page 5 of 5 form HUD-40055

(06/2016)

_________________________________________________________________________________________________________

(NOTE: Updated to incorporate MAP21 statutory changes to the URA effective on 10/01/2014. Please note the current URA regulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP21 changes. For additional informationon MAP21changes to the URA for HUD programs and projects, refer to HUD Notice CPD1409 at the following website: http://portal.hud.gov/hudportal/documents/huddoc?id=1409cpdn.pdf.)

H49515

Text Box

Privacy Act Notice. This information is being used by an agency administering program services on behalf of HUD for certain HUD programs for displaced businesses, nonprofit organizations, and farm operators that wish to apply for a Payment for Actual Reasonable Moving and Related Expenses, including Reestablishment Expenses, rather than apply for a Fixed Payment. (The maximum Fixed Payment is $40,000). Periodically, HUD reviews a random sample of the agency files to ensure compliance with statutory and regulatory requirements. The information requested is voluntary, you are not required by law to furnish this information, but if you do not provide it, you may not receive this payment or it may take longer to pay you. The Agency will explain the difference between the two types of payments. If you are eligible to choose either payment, the Agency will help you to determine which is most advantageous. If the full amount of your claim is not approved, the Agency will provide you with a written explanation of the reason. If you are not satisfied with the Agency’s determination, you may appeal the determination. The Agency will explain how to make an appeal. This information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended. The information may be made available to a Federal Agency and other agencies approved by HUD to administer or assist with Uniform Relocation Assistance and Real Property Acquisition Policies Act obligations.

H49515

Text Box

Public reporting burden for this collection of information is estimated to average 1.5 hours per response. This includes the time for collecting, reviewing, and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, and implementing regulations at 49 CFR 24 and will be used for determining whether you are eligible to receive a payment for moving and related expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

Previous editions are obsolete Page 1 of 3form HUD-40056(06/2016)

Section A. General1. Name of Business, Farm or Nonprofit Organization 2. Name, Title, Address & Telephone Number of Claimant or

Claimant's Authorized Agent

3. Address from which Business, Farm or Nonprofit Organization Moved

4a. Date Move Started (mm/dd/yyyy) 4b. Date Move Completed (mm/dd/yyyy)

4c. Address to which Business, Farm or Nonprofit Organization Moved(If Business, Farm or Nonprofit Organization went out of business, check here )


Claim for Fixed Paymentin Lieu of Payment for Actual NonresidentialMoving and Related Expenses(49 CFR 24.305)



5. Type of Operation (check one) 6. Type of Ownership 7. Is This a Final Claim? Business Farm Operation Sole Proprietorship Corporation Yes No (If "No", attach

Nonprofit Organization Partnership Nonprofit Organization explanation)

Instructions: This claim form is for the use of displaced businesses, nonprofit organizations, and farm operators that wish to claim a FixedPayment, rather than claim a Payment for Actual Reasonable Moving and Related Expenses, including Reestablishment Expensesunder the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (URA). The minimum fixed payment is$1,000; the maximum is $40,000. This payment is based on the average net annual earnings of an eligible business or farm operationbefore income taxes during the 2 tax years prior to the tax year in which it was displaced (see 49 CFR 24.305(e)); or for a nonprofit organi-zation, based on the average of 2 years gross annual revenues less administrative expenses for the two 12 month periods prior to theacquisition (see 49 CFR 24.305(d)). The Agency will explain the difference between the two payments and will help you complete thisform. HUD provides information on these requirements and other guidance materials on its website at www.hud.gov/relocation. If you areeligible for either payment, the Agency will help you to determine which is most advantageous. If the full amount of your claim is notapproved, the Agency will provide you with a written explanation of the reason. If you are not satisfied with the Agency’s determination, youmay appeal the determination. The Agency will explain how to make an appeal.All claims for payments must be filed no later than 18 months from the date of displacement (see 24.207(d)).

Fixed Payment Eligiblity: 1. Business: (see 49 CFR 24.305(a)), 2. Nonprofit Organization: (see 49 CFR 24.305(d)) & 3. FarmOperation: (see 49 CFR 24.305(c))

Certification of Legal Residency in the United States (Please read instructions below before completing this section.)

Instructions: To qualify for relocation advisory services or relocation payments authorized by the Uniform Relocation Assistance and RealProperty Acquisition Policies Act, a “displaced person” must be a United States citizen or national, or an alien lawfully present in the UnitedStates. The certification below must be completed in order to receive any relocation benefits. (This certification may not have anystanding with regard to applicable State laws providing relocation benefits.) Please address only the category that describes your citizen-ship status. For item (2), please fill in the correct number of partners. The certification for a nonresidential displaced person may be signedby an owner or other person authorized to sign on its behalf.Your signature on this claim form constitutes certification. See 49 CFR 24.208(g) & (h) for hardship exceptions.

NONRESIDENTIAL DISPLACEMENTS(1) Sole Proprietorship. (2) Partnership. (3) Corporation. (Name of Corporation)I certify that I am: (check one) I certify that there are ______ partners in the I certify that ___________________,_____ a citizen or national of the United States partnership and that______ are citizens or is established pursuant to State law and is_____ an alien lawfully present in the nationals of the United States and _____ are authorized to conduct business in theUnited States. aliens lawfully present in the United States. United States.

Appendix 054 - Non-Residential Payment in Lieu

1/ This is usually the two tax years prior to your displacement. Pleaseconsult the Agency.

2/ To the extent that the profit/income entry in Section B, line (1), (5) or(9) has been reduced by an expense that was not incurred in the baseperiod (e.g., a loss carry forward from a previous year, loss carry backfrom a later year or declared depreciation in excess of actual depre-ciation) such expense must be added back on line (2), (6) or (10). Tothe extent that the entry on line (1), (5) or (9) is inflated by an amountnot actually earned in the base period (e.g., refund of State or localincome taxes or income included under the tax benefit rule becausea deduction taken in a previous year was disallowed), it should beentered on line (2), (6) or (10) as a subtraction.

Table I. Individual or Sole Proprietor (Relates to IRS Form 1040)$ $ $ $

$ $ $ $

(1) Net Profit (Or loss) Before Taxes from IRS Form 1040

(2) Adjustments (Attach statement)

(3) Compensation Paid to Owner, Owner's Spouse, andDependents (List names and amounts to each on aseparate page)

(4) Net Earnings (Add lines (1), (2) and (3))

Table II. Corporation (Relates to IRS Form 1120 and 1120-S)

(5) Taxable Income from IRS Form 1120(Or ordinary income from IRS Form 1120-S)


(7) Compensation Paid to Principal Stockholders, theirSpouses, and Dependents (List names and amounts toeach on a separate page)

(8) Net Earnings (Add lines (5), (6) and (7))

Table III. Partnership (Relates to IRS Form 1065)

(9) Ordinary Income (Or loss) BeforeTaxes (From IRS Form 1065)


(11) Compensation Paid to Principal Partners, their Spouses, and Dependents (List names and amounts to

each on a separate page)

(12) Net Earnings (Add lines (9), (10), and (11))

Table IV. Nonprofit Organization(13) Annual Gross Revenues

(14) Administrative Expenses

(15) Net Revenues (Subtract line (14) from line (13))

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

2/

2/

3/

2/

4/

5/

6/

For Agency Use OnlySection B. Computation of Average NetEarnings or Net Revenues for Base Period 1/

Base PeriodItem Year (yyyy) Year (yyyy) Average

3/ Principal stockholder is one who owns 15% or more of thecorporation.

4/ A principal partner is one with a proprietary interest of15% or more in the concern.

5/ Gross revenues may include membership fees, classfees, cash donations and other fund collections.

6/ Administrative expenses include rent, utilities, salariesand fund raising costs.

Section C. Computation of Payment Item Amount Claimed For Agency Use Only (1) Amount from line (4), (8), (12) or (15) of Section B (If less than $1,000, enter $1,000. If more than $40,000, enter $40,000)

(2) Amount Previously Received (if any)

(3) Amount Requested (Subtract line (2) from line (1))

$ $

$ $

Page 2 of 3 form HUD-40056

(06/2016)

Previous editions are obsolete Page 3 of 3 form HUD-40056 (06/2016)


2. Recommended $

3. Approved $

To Be Completed by Agency

Section D. Certification By Claimant(s): I certify that the information on this claim form and supporting documentation is true and complete and that Ihave not been paid for these expenses by any other source.

Signature(s) of Claimant(s) or Claimant's Authorized Agent TItle (Type or Print) Date

X

Payment Action Amount of Payment Signature Name (Type or Print) Date

Remarks

Public reporting burden for this collection of information is estimated to average 1.0 hours per response. This includes the time for collecting, reviewing, and reporting the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, and implementing regulations at 49 CFR Part 24 and will be used for determining whether you are eligible to receive a fixed moving payment instead of a payment for actual moving and related expenses and the amount of any payment. Response to this request for information is required in order to receive the benefits to be derived. This Agency may not collect this information, and you are not required to complete this form unless it displays a currently valid OMB control number.

NOTE: (Updated to incorporate MAP21 statutory changes to the URA effective on 10/01/2014. Please note the current URAregulations of 49 CFR part 24 will be revised in a future URA rule making to reflect MAP21 changes. For additional informationon MAP21 changes to the URA for HUD programs and projects, refer to HUD Notice CPD1409 at the following website: http://portal.hud.gov/hudportal/documents/huddoc?id=1409cpdn.pdf)

Privacy Act Notice: This form is for the use of displaced businesses, nonprofit organizations, and farm operators that wish to apply to a Fixed Paymentrather than a Payment for Actual Reasonable Moving and Related Expenses, including Reestablishment Expenses. (The maximum Fixed Payment is$40,000.) The Agency will explain the difference between the two types of payments. If you are eligible to choose either payment, the Agency will help

you determine which is most advantageous. If the full amount of your claim is not approved, the Agency will provide you with a written explanation of

the reason. If you are not satisfied with the Agency's determination, you may appeal the determination. The Agency will explain how to make an appeal.

This information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970. The

information may be made available to a Federal Agency for review.

H49515

Underline

H49515

Underline

Appendix 055 - Residential Relocation Management Report

Appendix 056 - Non-Residential Relocation Management Report


GENERAL URA ACQUISITION PROCESS (Refer to 49 CFR 24 Subpart B for detailed acquisition requirements)

VOLUNTARY ACQUISITIONS 49 CFR 24.101(b)(1)-(5)

INVOLUNTARY ACQUISITIONS 49 CFR 24.101(a) & (b)

Determine if proposed acquisition satisfies criteria and requirements of 24.101(b)(1)-(5). If acquisition doesn’t meet criteria (e.g., is subject to threat or use of eminent domain), refer to involuntary acquisition process and comply with 49 CFR 24 Subpart B requirements.

Determine if proposed acquisition is subject to threat or use of eminent domain. If not subject to eminent domain, refer to voluntary acquisition process and comply with applicable requirements of 49 CFR 24.101(b)(1)-(5).

24.101(b)(1) - Agencies with eminent domain authority but will not use: must meet all conditions of 24.101(b)(1)(i) –(iv). (see esp. 24.101(b)(1)(i) & (ii))

* Notify owner of agency’s interest inacquiring property and protections underthe Uniform Act (see 24.102(b))(Optional: issue Notice of Intent to Acquire(see 24.203(d))

* Agency will not acquire property ifnegotiations fail, and owner is so informedin writing (see 24.101(b)(1)(iii))

* Appraise property and invite owner toaccompany appraiser(see 24.102(c))

* Agency informs owner in writing ofproperty’s estimated market value(see 24.101(b)(iv))

* Review the appraisal(see 24.104)

* Owner/s & owner occupants not eligiblefor relocation assistance / displacedtenants may be eligible (see 24.2(a)(9)(ii))

* Establish estimate of just compensationfor property(see 24.102(d))

24.101(b)(2) – Agencies or persons without eminent domain authority:

* Provide owner with written offer andsummary statement for property(see 24.102(e))

* Prior to offer, inform owner unable toacquire if negotiations fail(see 24.101(b)(2)(i))

* Negotiate with owner for purchase ofproperty(see 24.102(f))

* Inform owner of property’s estimatedmarket value(see 24.101(b)(2)(ii))

* If negotiations successful, complete saleand reimburse property owner for relatedincidental expenses (see 24.106)


* If negotiations unsuccessful, consider anadministrative settlement(see 24.102(i))

24.101(b)(3) – Acquisition from a Federal agency, State, or State agency, if acquiring agency without eminent domain authority:

* If negotiations still unsuccessful, consideracquiring property through eminentdomain.


* Displaced persons eligible for relocationassistance(see 24.2(a)(9)(i))

App. 23 [03/07]

Appendix 057 - Comparison Chart Voluntary vs. Involuntary Acquisition

Appendix 24

24-1

Acquisition Checklist (Guideform) Project: _______________________________________________________ Preliminary Title Opinion ____/____/______ Acquisition Case Number: ______________________________________ Property Survey ____/____/______ Address of Property Proposed for Acquisition: Request For Environmental Review ____/____/______

____________________________________________ Environmental Clearance ____/____/______ ____________________________________________ LBP Test Requested (if applicable) ____/____/______

Property Owner: ____________________________________________ LBP Test Results ____/____/______ Owner’s Address: ____________________________________________ If Decision Not To Acquire, ____/____/______

____________________________________________ Why ___________________________________________

Acquisition Actions Amount Date of Action Date of Action Relocation Actions (if applicable) Initial Contact With Owner ____/____/______ ____/____/______ Occupant Survey Letter of Interest/Notice to Owner ____/____/______ ↔ ____/____/______ 1) General Information Notice(s) Brochure information provided w/Letter [ ] Yes - [ ]No [ ] Yes - [ ]No Brochure info. provided w/Notice

____/____/______ - - Receipt(s) to prove deliveryInvitation to Accompany Appraiser (if applicable) ____/____/______ Appraisal (if applicable) $________ ____/____/______ Review Appraisal (if applicable) $________ ____/____/______ Establishment of Just Compensation $________ ____/____/______ Offer Letter $________ ____/____/______ ↔ ____/____/______ 2) Initiation of Negotiation Notice(s) Summary Statement Included [ ] Yes - [ ]No [ ] Notice of Eligibility Admin. Settlement (if applicable) $________ ____/____/______ [ ] Notice of Nondisplacement Eminent Domain Filed (if applicable) ____/____/______ ____/____/______ - - Receipt(s) to prove delivery Court Decision Rendered (if applicable) ____/____/______ Relocation case files related to this acquisition: Amount of Court Award (if applicable) $________ _________________________________________________ Closing/Settlement Statement ____/____/______ _________________________________________________ Proof of Title (Doc.) ____________________________ ____/____/______ _________________________________________________ Final Title Opinion ____/____/______ _________________________________________________ Date Title Document Recorded ____/____/______ _________________________________________________ Acquisition Payment /Court Deposit $________ ____/____/______ NOTE: The symbol “↔” is inserted at these two stages to remind displacing agencies that these notices are to be sent simultaneously.

Appendix 058 - Acquisition Checklist

Appendix 059 - Monitoring Checklist, Acquisition EXHIBIT 1

Acquisition Checklist

Part I - Application Review

Contains a statement regarding compliance with URA Define voluntary and involuntary acquisition procedures Explains requirement regarding seller notification and estimate of fair market value If relocation is involved, requires the following be submitted at the application

List of occupants currently on site and who left within last 6 months Explanation for any occupant departures in six (6) months prior to application Description of the number of households expected to be displaced Defines relocations as permanent or temporary or none Estimate of relocation costs Source and commitment of funding for relocation Application contains a map of project, list of parcels to be purchased and identification of all

property owners. Application identifies all activities connected to the site, including any prior property

acquisition Application to contain a statement of interest of all parties in the acquisition

Part II - Acquisition Review at Application -Voluntary Acquisition

Governmental and Non-Governmental Entities)

Any letters of interest/negotiation (optional) Voluntary Letter or Language in Purchase Agreement Voluntary Letter Delivery Evidence of Fair Market Value/Basis for amount established (appraisal/other value) Purchase Agreement Tax credit projects - statements and/or documentation of any identity of interest

Governmental Entities Only

Statement/Evidence that project is not in a designated area where all of the properties are to be acquired

Statement that agency will not acquire, if negotiations fail

Part III - Acquisition Review Involuntary Acquisition (Governmental Entities Only)

Letter to Appraise Offer of Just Compensation/Summary Statement Letters of Negotiation Appraisal Review Appraisal Purchase Agreement with Seller Administrative Settlement Justification If litigation, court settlement papers

1

Part IV - Acquisition Review at Project Approval

Resolution of any identity of interest issues Final Escrow Documents Subrecipient or other funded entity approval document Executed agreement with Subrecipient or other funded entity

Part V - Acquisition Review at Project Completion Review

Deed Recordation File Documentation Review - Include all documents listed above

Part VI - Project Review (Check program for definition of project otherwise use URA)

Project Information (where several parcels/owners involved). Map of Project showing project boundaries List of parcels in project and which are being acquired List of all owners and property addresses Sources and uses chart showing all properties/sources of funding

2

Appendix 060 - Monitoring Checklist, Relocation

Part I - Application/Planning Review

A. Review applicability of URA

CDBG-DR Funded?Demolition/Conversion of low income unitsOne for One Replacement StatusCorrect notices and benefits formula

B. Occupant Status

Names/addresses of who (which units) will be displaced?Whether relocation is temporary or permanentWill some tenants stay and other tenants go?

Based on income requirement Based on tenant characters- seniors/disabled/overcrowded Will rents for some tenants go up?

If no occupant list is available, a list of how many units/households of what type occupied/to be displaced

C. Preliminary Estimate of Costs

Number of household by units/bedroom sizeCurrent rents in building Current rents in area/ project rentsPossible low income Are some tenants not in U.S. legally?If exact information not available, develop a range of relocation costs (from no low income occupants

to all low income occupants) If temporary relocation - (Less than twelve (12) months)

How many persons for how long Type of out of pocket: moving, housing/utilities, food

D. Relocation Staffing

Request Name of Organization who will carry out relocationRequest statement of relocation experienceDoes sub-recipient/consultant have appropriate experience

HUD project/regulations Housing versus business Size of project

Did the application explain who will carry out tile following relocation functions: Prepare estimates Interview occupants Send out notices Find comparable housing Calculate benefits Advisory services

1

E. Funding Source for Relocation

Name of entity/funding source for relocation provided Status of funds for relocation - If not now in place, is there a future commitment

F. Occupant Notification

Meetings with tenants (Date, presenter, type of info) General Information Notice GIN

Date to be issued Delivery method Wording

Part II – Application/Relocation Checklist - Project Approval Review

Meeting with Sub-recipient/Developers/sponsor/to address Status of Relocation A. Review Relocation Staffing

Who is carrying out relocation: If consultant, is consultant on board:

B. Review General Information Notice

Status of GIN - has it been sent Review wording of GIN, if not already sent Review method of delivery of GIN, if not already sent

C. Review Occupancy Lists

Who has moved in since application? Was there a move in notice? Compare current occupant list with one provided at application and request info on people who have

departed D. Review Final Relocation Plan

Final Number to be displaced has been determined Type of Displacement has been determined Final Estimate of Costs has been made Availability of Comparable Units has been determined Timeline for Issuing Notices Procedures for Filing Claims have been set up Advisory services have been defined and checklist prepared Appeal procedures have been set up Plan has been finalized according to state and HUD rules Legal residency status has been reviewed and considered.

2

E. Review Applicability

Review funding sources Correct Notices Correct Claim Forms Covered in the Relocation Plan Formula for benefits is correct Number of months is correct Applied to all low income Applied irrespective of U.S. residency status Need for One for One Replacement Plan

Part III – Application/Relocation Checklist – Contract Execution Review Conduct meeting with principals to address the following: A. Final Plan is Approved

Permanent Temporary

B. Occupancy List

Obtain list as of ION Compare with other occupancy lists (check for departures) Move in notices used and worded properly Presence of undocumented aliens

Use of exceptions approved Adjustments in calculation of benefits

Presence of Evictions – correct procedures followed Which tenants will be displaced Is there any temporary displacement

Plan in place Funding in place

C. Notices

GIN – Status Notice of Displacement/Notice of Eligibility

Wording approved Date to be sent Delivery method

Temporary Notices Wording approved Date to be sent Delivery method D. Status of Interviews with Tenants

3

Started Estimated Date of Completion Appeal Process in Place

E. Subrecipient or other funded entity Review Process

Status Reports to be provided regularly Procedure for file documentation has been set up

Part IV - Application/Relocation Checklist - Project Completion Review A. Occupancy List

Did everyone receive benefits? If no benefits, agency has reviewed and approved

Evictions were proper Agency has reviewed and approved

B. Review of Claim Forms

Forms completed correctly All Payments made Inspections completed for both in-town and out of town replacement housing Moving Expenses for Housing

Actual expenses supported by documentation received Fixed payment according to updated Federal FHWA schedule

C. Review of Rental Housing Replacement Housing

Comparable units - sufficient number and documented as comparable Calculations are supportable

Rent (Lease or rent receipts) Utilities Income

Referred to correct unit size Correct income schedule used Section 8 - Documentation of initial award or transfer Down payment documentation in file Legal residency issues

Exceptions approved or FHWA methodology used

D. Review of Homeowners Replacement housing

Provided, if acquisition was involuntary Replacement housing documented

E. Advisory Assistance

Assistance Documented

4

F. Review of Business Relocation

All equipment identified and accounted for (appraisal or other document) Re-establishment Moving expenses supported by bids/receipts

G. Other Review

Advisory Assistance Complaints settled Files Organized Properly

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