Real Property Status Report (Cover Page) (Page 4 of 13) in pdf

Real Property Status Report (Cover Page) Page 4

[ATTACHMENT C]

(Disposition Request)

Federal Grant or Other Identifying Number Assigned by Federal Agency (#2 on cover page)

Page:

of:

Pages

Complete the applicable blocks below for each parcel of real property for which you are seeking disposition

or other instructions (duplicate this page to provide information for each parcel of real property under the

Federal financial assistance award identified in section 2):

13a. Description of Real Property:

13b. Address of Real Property (legal description and complete address including zoning information):

13c. Acreage:

13d. Gross Square Meters and Usable Square Meters (i.e., of

building, house, etc.):

14a. Disposition Preference Request [Check one]:

___A. Sell

___B. Transfer to different award ___C. Use in other Federally sponsored project/program

D. Transfer title ___E. Retain Title. ____

14b. If this is a request to transfer to a different award, specify the proposed grant number and funding agency:

14c. If this is a request to use the real property in other Federal-sponsored projects/activities, describe the proposed use of the real

property:

14d. If this is a request to transfer title, identify the proposed receiving entity:

14e. Appraised Value:

Share Percentage %:

Federal Share:

[

Non-Federal Share:

[

Total (sum of Federal and Non-Federal Share):

[

14f. Are there any Uniform Relocation Act requirements applicable to this real property? ___ Yes ___ No

14g. Are there any environmental compliance requirements related to the real property? ___ Yes ___ No

If yes, describe them (Attach additional sheets if necessary):

14h. In accordance with the National Historic Preservation Act (NHPA), does the property possess historic significance, and/or is listed or

eligible for listing in the National Register of Historic Places? ___ Yes ___ No

If yes, describe them (Attach additional sheets if necessary):

15. If this is a request for a release from the obligation to report on the real property, describe the reasons for the request (attach

additional sheets if necessary):

16. Remarks (attach additional sheets if necessary):

Real Property Status Report (Cover Page) Page 4