SF-429-C Real Property Status Report ATTACHMENT C (Disposition or

OMB Control No.: 3090-0296
Expires: 07/31/2014
Real Property Status Report

ATTACHMENT C

(Disposition or Encumbrance Request) SF-429-C
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). If a section does
not apply, enter “N/A”:
13a. Description of Real Property:

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

13c. Land Acreage or Square Units:
Enter Amount:________________
Select units: __Acres
__Square Feet
__Square Kilometers __ Square Meters

13d. Gross and Usable Square Footage/Meters (i.e., of building, house,
etc.):
Enter Amounts: Gross ___________ Usable ___________
Select Units: __Square Feet __Square Meters

14a. Disposition Preference or Encumbrance Request [Check one]:
___A. Sell
___B. Transfer to different award
___C. Use in other Federally sponsored project/program
D. Transfer title
___E. Retain Title
___F. Encumber Property
14b. If this is a request to transfer Federal Interest 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 (URA) 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 it listed or eligible for
listing in the National Register of Historic Places? ___ Yes
___ No
If yes, describe them (attach additional sheets if necessary):
14i. If this is a request to encumber the property, identify the party or parties to whom the property is proposed to be encumbered and attach related
information (See instructions for more details):

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):

Attachment C (Disposition or Encumbrance Request) to Real Property Status Report SF-429

iv

Standard Form 429 (9/2011)

OMB Control No.: 3090-0296
Expires: 07/31/2014

D. Instructions Related to Attachment C (Disposition or Encumbrance Request) follows:
Real Property Details. Complete the applicable information in subsections 13a. through 16. of Attachment C for
each parcel of real property for which the recipient is requesting disposition/encumbrance or other instructions. Use a
separate sheet to request disposition/encumbrance or other instructions on each parcel of real property under the
Federal financial assistance award identified in section 2. If a section does not apply, enter “N/A.” Below is a summary
of the required information to be provided for each subsection of Attachment C:
13a. Description of Real Property. Describe the type of real property that is the subject of this request (i.e., land,
building, etc.) and a useful description of the real property (i.e., building number 17 at the National Research Center,
Chapel Hill, NC).
13b. Address of Real Property. Enter the legal description and complete address for each parcel of real property
including the street, city, state, county/parish, country, zip code, and physical location if an address is not available
(i.e., latitude, longitude, lot number, parcel number, etc.). Also, indicate zoning information related to the real
property (i.e., mixed use, residential, commercial, etc.). Where an address is not available, or more precision is
required, geographic coordinates may be used. Locational data should be recorded with a Global Positioning
System (GPS) device set to NAD 83, or WGS 84 datum using either of the following coordinate reference systems:
• United States National Grid (USNG) using the full grid zone designation and a minimum of eight digits.
• Decimal degrees latitude and longitude, with at least 6 decimal places and a minus (-) to show west

longitude or south latitude.

13c. Land Acreage or Square Kilometers. Enter the size of the land or the size of the land on which the real
property is located in terms of measured acreage or square units (i.e., 1.5 acres, 0.8 sq. km., etc.). Identify the unit
of measure. Use only one option, either acres, square kilometers, square feet, or square meters.
13d. Gross and Usable Square Footage/Meters (i.e., of building, house, etc.). Enter the gross and usable square
footage/meters for each structure (i.e., of the building, house, etc.) being reported. Identify the unit of measure. Select
only one, either square feet or square meters.
14a. Disposition Preference or Encumbrance Request [Check one]. Check the appropriate block (A – F) to indicate
the type of disposition/encumbrance instruction preference being requested. The award document will indicate the
disposition option(s) available. The recipient may not request a disposition preference that is not already allowed under
the award. Agencies will respond timely to all requests via letter, electronic mail and/or other appropriate means.
14b. If this is a request to transfer Federal Interest to a different award, specify the proposed grant number
and funding agency. If the recipient is proposing to transfer the Federal interest to a different award, specify the
grant number and funding agency for the award to which the recipient is proposing to transfer the interest.
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. If the recipient is proposing to use the real property to provide services or
facilities for other Federal-sponsored projects or activities, identify the other Federal projects or activities and how
the real property will be utilized. Also, describe any impact expected on the host Federal project or activity due to
the proposed additional use of the real property. Attach additional sheets if necessary.
14d. If this is a request to transfer title, identify the proposed receiving entity. If applicable, provide contact
information for the proposed receiving entity.

xiii

Standard Form 429 (9/2011)

OMB Control No.: 3090-0296
Expires: 07/31/2014

14e. Appraised Value. Enter the third party appraised value of the real property (current market value), including
the following:
1. Amount provided by the Federal government (i.e., Federal Share of Appraised Property Value cost based
on the Federal share of the total cost of the program or project),
2. Share percentage provided by the Federal government (i.e., Federal Share Percentage of Appraised Property
Value based on the Federal share of the total cost of the program or project),
3. Amount provided by the recipient or other non-Federal entities (i.e., non-Federal Share of Appraised

Property Value),

4. Share percentage provided by the non-Federal entities, (i.e., non-Federal Share Percentage of Appraised
Property Value),
5. Total cost (i.e., Sum of Federal and non-Federal Share of the Appraised Value), and
6. Total share percentage (i.e., sum of share percentages of Federal and non-Federal Share of the Appraised
Property Value).
14f. Are there any Uniform Relocation Act (URA) requirements applicable to this real property? If the
acquisition or development of the real property involved the movement of any person permanently from real property
or the movement of personal property from real property directly because of acquisition, rehabilitation, or demolition
for an activity undertaken with Federal assistance, the Uniform Relocation Act (URA) requirements may apply. Indicate
if the Act does apply by checking “yes or no”. If the Act does apply, the recipient must maintain records of compliance
and make such information available upon the request of the Federal government.
14g. Are there any environmental compliance requirements related to the real property? If yes, describe
them. Check either “yes” or “no” to indicate if there are any environmental compliance requirements related to the
real property. Describe any environmental compliance requirements related to the real property. The recipient
must maintain records of compliance with all environmental requirements related to the real property and make such
information available upon the request of the Federal government. Attach additional sheets if necessary.
14h. In accordance with the National Historic Preservation Act (NHPA), does the property possess historic
significance, and/or is it listed or eligible for listing in the National Register of Historic Places? If yes,
describe them. In accordance with the Section 106 of 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?
Describe any historical significance, National Register of Historic Places listing or eligibility for such listing, related to
the real property. Note, any property listed in, or eligible for listing in the National Register of Historic Places is
considered historic. Section 106 protections also extend to properties that possess significance but have not yet
been listed or formally determined eligible for listing.
14.i. If this is a request to encumber the property, identify the party or parties to whom the property is
proposed to be encumbered and attach related information: Identify the party/parties to whom the property
is proposed to be encumbered and attach the proposed form and terms of encumbrance, along with a copy of
any proposed subordination, inter-creditor agreement, or other documentation to protect the interests of the
U.S. Government in case of default.
15. If this is a request for a release from the obligation to report on the real property, describe the
reasons for the request. Describe the recipient’s reasons for requesting a release from the obligation to report.
Examples of acceptable reasons include but are not limited to expiration of Federal interest or the real property
being disposed of in accordance with agency direction. Attach additional sheets if necessary.
16. Remarks. Enter any explanations deemed necessary or information required by the Federal agency including
any remarks that the recipient would like to make to address issues that are not addressed elsewhere in this request.
Attach additional sheets if necessary.

xiv

Standard Form 429 (9/2011)