SF-429 Real Property Status Report SF-429

REAL PROPERTY STATUS REPORT SF-429
(COVER PAGE)
1. Federal Agency and Organizational Element to Which Report is Submitted:

OMB Number: 4040-0016
Expiration Date: 02/28/2025

2. Federal Grant(s) or Other Identifying Number(s) Assigned by
Federal Agency(ies):

3. Recipient Organization (name and complete address including zip code):
Recipient Organization Name:
Street1:
Street2:
City:

County:
Province:

State:
Country:

USA: UNITED STATES

4a. UEI:

4b. EIN:

ZIP / Postal Code:
5. Recipient Account or Identifying Number:

6. Contact Person for this Report:
Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Email:
Fax:

Phone:
7. Report End Date:
(MM/DD/YYYY)

8. Real Property Status Report – Attachments: [check the applicable block(s)]:
: Attachment A (General Reporting) attached
: Attachment B (Request to Acquire, Improve or Furnish) attached
: Attachment C (Disposition Request) attached
9. Comments:

Add Attachment

Delete Attachment

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10. Certification: I certify to the best of my knowledge and belief that all information presented in this report is true, correct and complete
and constitutes a material representation of fact upon which the Federal government may rely.
11a. Typed or Printed Name and Title of Authorized Certifying Official:
Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Title:
11b. Signature of Authorized Certifying Official:

11c. Telephone (area code, number, extension):

11d. Email Address:

11e. Date Report Submitted (MM/DD/YYYY):

12. Agency use only