REPORT CONTROL SYMBOL
DETERMINATION OF RELOCATION BENEFITS DUE APPLICANT
DAEN-RE-18
(ER 405-1-12)
PROJECT
NAME AND ADDRESS OF APPLICANT
APPLICATION NUMBER
TRACT NUMBER
The following is a determination of relocation benefits due the above applicant under Public Law 91-646; (In cases where all
benefits due cannot be paid at one time, such as in the case of annual rental payments, a record of payments will be set forth
in the payment record at the end of this form.)
1. MOVING EXPENSES:
$
a. Actual Residential
$
b. Fixed Residential
$
c. Actual Business Moving
$
d. Actual Business Storage
$
e. Business Direct Loss
$
f. Actual Business Searching
$
g. Fixed Business
$
h. Actual Farm Moving
$
i. Farm Direct Loss
$
j. Actual Farm Storage
$
k. Actual Farm Searching
$
l. Fixed Farm
$
TOTAL (Sum of a thru l, as they apply)
$
a. Additional Cost of House
2. REPLACEMENT HOUSING,
HOMEOWNERS:
b. Increased Interest
$
$
c. Closing Costs
TOTAL (Sum of a thru c, as they apply)
$
a. Supplemental Rental Payment
$
3. REPLACEMENT HOUSING,
TENANTS:
b. Down Payment
$
TOTAL (Sum of a or b, as applied)
$
4. INCIDENTAL EXPENSES:
$
a. Recording Fee
$
b. Transfer Taxes
c. Prepayment Costs
$
d. Prorated Real Estate Taxes
$
TOTAL (Sum of a thru d, as they apply)
$
ENG FORM 4439, 1 Nov 72
(Proponent: CERE-RA)