Agency Surplus Real Property Notification Form - Oregon Department Of Administrative Services

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State of Oregon
Agency Surplus Real Property Notification Form
Agency File Number:
Type of Notification:
Surplus
Trade/Exchange (Use Both Forms)
Transfer to another Agency
Futile Act Request
*Please provide justification narrative memo for the request per
OAR 125-045-0225 (5) & (9)
Department/Agency Name:
Property Size:
Property Current Use:
Property Address or Location
(location if address unknown):
Map Tax Lot
(Township, Range, Section, Tax lot number):
Closest Incorporated City:
Property County:
Property Description:
Other Real Property Assets attached to this property:
Check all that apply:
Water
Wetlands
Fish
Public Access
Hazardous Material
Minerals
Timber
Wildlife
Improvements
Restrictions
What is the Property Zoned?
Contact Person:
Phone Number:
Comments:
Yes
Note: A public comment opportunity is required when the real property
Map Attached:
has an appraised market value exceeding $100,000 before property can
No
be disposed of to a private entity according to ORS 270.105.
Signature:
Date:
Title / Agency:
Return form to:
Darrin W. Brightman,
Please E-mail:
Planner 3, Property Transactions Coordinator
Darrin.W.Brightman@oregon.gov
Enterprise Asset Management, Real Estate Services
Department of Administrative Services
and
1225 Ferry St SE U100, Salem OR 97301-4281
cc:
elaine.g.schacher@oregon.gov
A responding entity is expected to enter into a Pre-purchase Agreement or Memorandum of Understanding with the offering
agency within 60 days of responding to this notice.
125615 Land Surplus Notice
09-13-2017

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