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14b. ADDRESS OF REAL PROPERTY |
13. Period (MM/DD/YYYY) and Type of Federal Interest |
14c. Land Acreage or Square Units |
14d. Gross and Usable Square Footage/Meters (i.e., of House, Building, etc.) |
14e. Real Property Ownership Type(s) |
14f. Real Property Cost |
14g. Has a deed, lien, covenant, or other related documentation been recorded to establish Federal interest in the real property? |
14h. Has Federally required insurance coverage been secured for this real property? |
14i. Are there any Uniform Relocation Act (URA) requirements applicable to this real property? |
14j. Are there any environmental compliance requirements related to the real property? |
14k. 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? |
15. Has a significant change occurred with the real property, or is there an anticipated changed expected during the next reporting period? |
16i. If the Federal agency provided the recipient disposition instructions to sell or retain title to the real property, enter the amount of funds owed to the Federal government: |
16ii. If applicable, enter the amount of any net proceeds from the sale of the real property and describe how the proceeds were distributed: |
16iii. If the Federal agency directed the recipient to transfer title to the real property, enter the amount of funds the Federal Agency owes: |
17. Indicate the cumulative energy consumption for the previous 12 months: |
18. Remarks |
| Federal Grant or Other Identifying Number Assigned |
(REAL PROPERTY ADDRESS) Street1 |
Street2 |
City |
State |
Zip Code |
County |
Province |
Country |
Zoning Information |
GPS Location Longitude |
GPS Location Latitude |
14a. Description of Real Property |
From: |
To: |
Please use dropdown to select type of Federal Interest (Acquisition, Renovation, Construction, or Government Furnished Property) |
Amount |
Please use the dropdown to specify whether it is acres, square feet, square kilometers, or square miles. |
Gross |
Usable |
Select Units (Please specify Square Feet or Square Meters) |
If applicable, please use the dropdown to make selection. |
Amount: Federal |
Amount: Non-Federal |
Total (Sum of Federal and Non-Federal Share) |
Please use the dropdown to make your selection. |
If yes (unless previously reported), describe the instrument used and enter the date and jurisdicton in which it was recorded. Also, please provide the "date" and "jurisdiction". |
Please use the dropdown to make your selection. |
Please use the dropdown to make your selection. |
Please use the dropdown to make your selection. |
If yes, please describe them. |
Please use the dropdown to make your selection. |
If yes, please describe them. |
Please use the dropdown to make your selection. |
If yes, please describe the change. |
If applicable, please specify the amount below. |
If applicable, please specify the amount below. |
If applicable, please specify the amount below. |
Please specify the type of energy (Electric (kWh), Electric (Btu), Petroleum (Gal), Natural Gas (cu ft), or Other (Specify)) and the cumulative energy consumption amount for the previous 12 months. |
Please use this column to make any necessary remarks and/or comments. |