Moving Expenses Worksheet Residential – (49 CFR 24.301) Airport: Project: Sponsor: Parcel: County: Unit: Claimant Name: 1. Type of Payment claimed: Fixed payment $ Reimbursement of Actual Expense Supplementary Claim for Storage (complete item 2 including any Cost (complete item 3) storage cost) 2. Actual Moving Expenses Amount Claimed For Agency Use (See below for Eligible and Non-eligible Expense) Only a. Moving Costs b. Transportation Costs - Families and Individuals (if any) c. Cost of Insurance (Move and Storage) d. Storage Costs (complete item 3) e. Other: (explain under Remarks below) Total Amount Claimed $0.00 $0.00 Less Amount of Advanced Payments (if any) Total Amount Due $0.00 $0.00 3. Storage Cost (complete only if personal property was moved to and from storage) Type of Claim: Date Property Moved Date Property Moved Storage Location: Initial Supplemental Final with Mover TO Storage: FROM Storage: other location Eligible Moving Expenses Ineligible Expenses The actual, reasonable, and necessary expense for: Cost of moving structures or other real property improvements. Transportation of individuals, families, and personal property from the Interest on a loan of funds for acquired site to the replacement site not to exceed a distance of 50 miles, moving costs. (unless the 50 mile limit is waived for cause by the agency). Additional expense because of Packing and unpacking, crating and uncrating of personal property. living in a new location. Disconnecting, dismantling, removing, reassembling, and reinstalling Personal injury. relocated household appliances, and other personal property. Any legal fee or other cost for Storage of personal property as necessary intransit up to 12 months, preparing a claim for a relocation (unless extended by the agency if necessary). payment or for representing the Insurance for the replacement value of the property moved and/or stored. claimant before the agency. The replacement value of property lost, stolen, or damaged in the move, Expense to search for a not through the fault or negligence of the displaced person, or his/her replacement residence. agent or employee; where insurance coverage for such items is not Improvement to the replacement available at reasonable cost. real property. Remarks:
Moving Expenses Worksheet – Residential (49 CFR 24.301) Airport: Project: Sponsor: Parcel: County: Unit: Claimant Name: 1. Type of Payment claimed: Fixed payment $ Reimbursement of Actual Expense (complete item 2 including any storage cost) Supplementary Claim for Storage Cost (complete item 3) 2. Actual Moving Expenses (See below for Eligible and Non-eligible Expense) Amount Claimed For Agency Use Only a. Moving Costs b. Transportation Costs - Families and Individuals (if any) c. Cost of Insurance (Move and Storage) d. Storage Costs (complete item 3) e. Other: (explain under Remarks below) Total Amount Claimed $0.00 $0.00 Less Amount of Advanced Payments (if any) Total Amount Due $0.00 $0.00 3. Storage Cost (complete only if personal property was moved to and from storage) Type of Claim: Initial Supplemental Final Date Property Moved Date Property Moved Storage Location: with Mover other location TO Storage: FROM Storage: Eligible Moving Expenses The actual, reasonable, and necessary expense for: Transportation of individuals, families, and personal property from the acquired site to the replacement site not to exceed a distance of 50 miles, (unless the 50 mile limit is waived for cause by the agency). Packing and unpacking, crating and uncrating of personal property. Disconnecting, dismantling, removing, reassembling, and reinstalling relocated household appliances, and other personal property. Storage of personal property as necessary intransit up to 12 months, (unless extended by the agency if necessary). Insurance for the replacement value of the property moved and/or stored. The replacement value of property lost, stolen, or damaged in the move, not through the fault or negligence of the displaced person, or his/her agent or employee; where insurance coverage for such items is not available at reasonable cost. Ineligible Expenses Cost of moving structures or other real property improvements. Interest on a loan of funds for moving costs. Additional expense because of living in a new location. Personal injury. Any legal fee or other cost for preparing a claim for a relocation payment or for representing the claimant before the agency. Expense to search for a replacement residence. Improvement to the replacement real property. Remarks:
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