SF-429-A Real Property Status Report ATTACHMENT A (General Reporting)

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Real Property Status Report
ATTACHMENT A (General Reporting) SF-429-A
Federal Grant or Other Identifying Number Assigned
by Federal Agency (#2 on cover page)

Complete the applicable b locks below for each parcel of real propert� being reporte � (du_p!ica!e this _Page '.o provide information for each
parce1 of reaI property being reported under the Federal financial assistance award 1dcnt1f1ed in section 2).

0 Acquisition O Renovation

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From:I

13. Period and type of Federal Interest (MM/OO/YYYY):

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To: I

0 Government Furnished Property

O Construction

14a. Description or Real Property:

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14b. Address of Real Property (legal description and complete address including zoning information):
Stroet1:

Street2:

City:

State:

Country:

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Zoning Information:

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14c. Land Acreage or Square Units:
Select units:

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II
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GPS Location Latitude:

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0 Acres
D Square Feet
0 Square Kilometers D Square Meters

Gross

Select units:

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141. Real Property Cost:
Federal Share:

J. Other (Describe):

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□
□

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0. Corporate

H. Co-Operative

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I 1[:==)%1
I IC=:]%1
I IC=:]%1

$1

Total (sum of Fodera/ and Non-Federal Share):$

Usable

Share Percentage %:

$
$1

Non-Federal Share:

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I

0 Square Feet D Square Meters

D B. Co-Owned 0 C. Fee Simple
□ E. Joint Tenancy 0 F. Partnership 0 G. Limited Liability Partnership

D

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Enter Amounts:

0 A. Owned

I. Government Furnished Property

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14d. Gross and Usable Square Footage/Meters (i.e., of building, house, etc.):

14e. Real Property Ownership Type(s):

□

Province:

ZIP I Postal Code:

GPS Location Longitude:

Enter Amount:

County:

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14g. Has a deed. lien. covenant. or other related documentation been recorded to establish Federal interest in this real property?

D

Yes

□

No

□

N/A

If yes (unless previously reported), describe the instrument used and enter the date and jurisdiction in which it was recorded:

Date:

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I Jurisdiction: I

14h. Has Federally required insurance coverage been secured for this real property?
See instructions for more details.

0 Yes □ No

14i. Are there any Uniform Relocation Act (URA) requirements applicable to this real property?
14j. Are there any environmental compliance requirements related to the real property?
If yes, describe them:

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11

j(1

1t2cnm..,1,.

0Yes

D Yes □ No

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□

No

11 Cc:le'e ,-.,acr;n� 111 II "e,•, AHat:.t,me 1 I

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