Form Sfn 10133 - Billboard Memorandum Agreement Form printable pdf download

BILLBOARD MEMORANDUM AGREEMENT

North Dakota Department of Transportation, Environmental & Transportation Services

SFN 10133 (Rev. 01-2009)

Project Number

Primary Parcel Number

Project Control Number

Additional Parcel(s)

On this __________ day of _______________________, 20___, ______________________________________

__________________________________________________________________________________________

did agree to convey to the state of North Dakota for removal by the (North Dakota Department of Transportation)

or (owner) a sign in ________________________ County located on the above-identified parcel(s), consisting of

_____________________ (sign) or signs whose dimensions are listed below, for a total of $________________

for said sign removal. No compensation will be paid until the sign structure has been totally removed.

The undersigned hereby certifies that they have a valid lease, either written or verbal, to erect and maintain the

billboards herein recited.

This agreement is now made and entered as a memorandum of all of the terms, and the only terms, agreed upon

in connection with above transaction.

The North Dakota Department of Transportation (NDDOT) hereby makes settlement with the seller/owner for the

following sign, or signs:

This sign, or signs, shall be disposed of in the following manner:

a. NDDOT takes complete possession of and retains the right of ultimate removal or destruction, and grants

_______ days of occupancy, ending the ___________ day of _____________________, 20___.

b. The seller/owner hereby agrees to remove said sign, or signs, from the right of way prior to ______________,

20___, at no additional cost to NDDOT. It is further agreed that if said sign, or signs, (is) (are) not removed

prior to the above date, the right of ownership and removal or destruction reverts to NDDOT; and NDDOT

holds the right to deduct removal costs from agreed payment.

REMARKS:

Sign Buyout & Removal

$_____________________________

__________________________________

Less Salvage Value

$_____________________________

__________________________________

Sign Move

$_____________________________

__________________________________

TOTAL

$_____________________________

__________________________________

The seller/owner will be notified in writing by the Design Engineer if this settlement is not approved. As a

memorandum agreement of the parties, the undersigned, do hereby execute and deliver this document. This

agreement was reached without coercion, promises other than those shown in the agreement, or threats of any

kind whatsoever, by or to either party. The Realty Officer has no direct or indirect, present or contemplated future

personal interest in the parcels or in any benefit from the acquisition of such property.

NORTH DAKOTA

SELLER/OWNER

DEPARTMENT OF TRANSPORTATION

Company Name

Realty Officer (Type or Print)

Name & Title (Type or Print)

Signature

Date

Form Sfn 10133 - Billboard Memorandum Agreement Form

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