HUD-40061 Selection of Most Representative Comparable Replacement

Selection of Most Representative

Comparable Replacement Dwelling

for Computing a Replacement Housing Payment
1. Agency

OMB Approval No. 2506-0016
(exp. 07/31/2008)

U.S. Department of Housing
and Urban Development
Office of of Community Planning
and Developmemt

2. Project

3. Household

4. Select One

5.Case Number

Owner
Tenant

Public reporting burden for this collection of information is estimated to average 1.0 hour. This includes the time for collecting, reviewing, and reporting
the data. The information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970,
and implementing regulations at 49 CFR Part 24 and will be used for determining the most comparable and available replacement housing and its cost to be
used by Agencies in computing a replacement housing payment for displaced persons. Response to this request for information is required in order to
receive the benefits to be derived. This agency may not collect this information, and you are not required to complete this form unless it displays a currently
valid OMB control number.
There is no assurance of confidentiality. This information is needed to determine whether you are eligible to receive a payment to help you rent or buy a
new home. You are not required by law to furnish this information, but if you do not provide it, you may not receive any payment for these expenses or it
may take longer to pay you. This information is being collected under the authority of the Uniform Relocation Assistance and Real Property Acquisition Policies
Act of 1970. The information may be made available to a Federal agency for review.
Factors (see back of page)
Displacement Dwelling
Comparable No.1
Comparable No.2
Comparable No.3
Address

Type of Unit
Stories / Style
Lot Size
Type of Construction
Age (in years)
Condition
Area of Living Space (sq. ft.)
No.Rooms/Bedrooms /Baths

/

/

/

/

/

/

/

/

Basement
Parking/No. of Cars
Type of Heating /Fuel

/

/

/

/

/

/

/

Type of Air Conditioning
Neighborhood
Transportation (distance)
Current Work (distance)
High School/Grade School (distance)

/

Neighborhood Shopping (distance)
Religious Facility (distance)
Sale Price or Rent/Utility Costs

$

$

$

$

Other
Date of Inspection
Date Available
Most Representative Comparable Replacement Dwelling
(Check "Comparable no.1, 2, or 3" and complete Comments)
Comments: Include appropriate analysis and correlation of data. If Agency makes adjustment to the asking price for a comparable replacement dwelling
to reflect the anticipated sale price, indicate the basis for the adjustment. For rental units, indicate utilities included in rent and provide estimates for other
utility costs. Indicate availability of any housing subsidy. If condominium or cooperative, indicate required fees. (Continue on back of page)

Comments continued on back of page
Prepared By

Previous editions are obsolete.

Yes

No
Date (mm/dd/yyyy)

Approved by

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Date (mm/dd/yyyy)

form HUD-40061 (04/2005)

Comments Continued:

Comments continued on a separate page

Yes

Factors

No

Examples

Type of Unit

Detached,Row, End Row, Townhouse, Highrise Apartment, Mobile Home (Indicate whether this is subsidized housing)

Stories

1, 11/2, 2, 21/2, Split Level, Split Foyer

Style

Colonial, Cape, Ranch, Contemporary, Tudor, Mediterranean

Type of
Construction

Frame, Masonry, Pre-Fab, Stone, Concrete Block, Concrete, Veneer (wood, brick, or aluminum siding)

Condition

Poor, Fair, Good, Very Good, Excellent

Basement

Full, Partial (1/2), None; Finished or Unfinished

Parking

Attached, Built-In, Detached, Carport Paved Open Area, Unpaved Open Area, None

Type of
Heating

Forced Air, Hot Water, Electric, Heat Pump, Steam, Space Heater, Solar, None

Type of Fuel

Natural Gas, Propane Gas, Oil, Electric, Coal, Solar

Type of Air
Conditioning

Central, Wall, Window, None

Neighborhood

Poor, Fair, Good, Very Good, Excellent. (Based on characteristics such as vacancy levels, quality and maintenance of dwellings,
landscaping, Street Maintenance, Trash Pickup, and Nonconforming land uses)

Other

Swimming Pool, Fireplace, Patio, Porch, Greenhouse

Previous editions are obsolete.

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form HUD-40061 (04/2005)