DI-382 Claim for Relocation Payments - Nonresidential - Schedul

OMB Control Number: 1084-0010
Expiration Date: 12/31/2021

DI-382 (03 -2019)
Department of the Interior

Schedule B
Direct Loss Of Personal Property – Nonresidential
(Under Sec. 202, P.L. 91-646, as amended)

Section 1 – To Be Completed By Claimant
1. NAME:

2. PROJECT/TRACT:

3. TANGIBLE PERSONAL PROPERTY:

-

=

ITEM
(list)

FAIR MARKET VALUE
FOR CONTINUED USE
AT PRESENT LOCATION

1.

$

$

$

0.00

$

2.

$

$

$

0.00

$

3.

$

$

$

0.00

$

4.

$

$

$

0.00

$

5.

$

$

$

0.00

$

6.

$

$

$

0.00

$

7.

$

$

$

0.00

$

8.

$

$

$

0.00

$

NET PROCEEDS
FROM SALE

VALUE NOT
RECOVERED
BY SALE

COST OF SALE: ...............................................................................................................

$

TOTAL: ................................................................................................................................

$

FOR AGENCY
USE ONLY

$

0.00

0.00

$

Actual direct loss of tangible personal property incurred as a result of moving or discontinuing the business or farm operation. The payment shall
consist of the lesser of: (i)The fair market value in place of the item, as is for continued use, less the proceeds from its sale. (To be eligible for
payment, the claimant must make a good faith effort to sell the personal property, unless the Agency determines that such effort is not necessary.
When payment for property loss is claimed for goods held for sale, the market value shall be based on the cost of the goods to the business, not the
potential selling prices.); or (ii) The estimated cost of moving the item as is, but not including any allowance for storage; or for reconnecting a piece of
equipment if the equipment is in storage or not being used at the acquired site. If the business or farm operation is discontinued, the estimated cost of
moving the item shall be based on a moving distance of 50 miles. The reasonable cost incurred in attempting to sell an item that is not to be relocated.
4. REMARKS: (Use other side if necessary)

5. RELEASE: I (We) hereby release to the displacing agency ownership and title to all personal property remaining on the acquired site, for which
the claimant has received or will receive a payment for direct loss of property.
SIGNATURE: ____________________________________________

SIGNATURE: ___________________________________________

DATE: _________________________________________________

DATE: _________________________________________________

Section 2 – To Be Completed By Agency
TOTAL COSTS ............................................................................................................................... $ _____________________
ESTIMATED COSTS OF MOVING PROPERTY ............................................................................ $ _____________________
PAYMENT

AMOUNT

SIGNATURE

TITLE

DATE

RECOMMENDED:

_________________

________________________________________

_________________

______________

APPROVED:

_________________

________________________________________

_________________

______________

FBMS INVOICE NO.:_________________

DI-382 Schedule B - Page 1 of 1