Illinois Department of Transportation, Milton R. Sees, Secretary Rod R. Blagojevich, Governor
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Bureau of Land Acquisition Forms

Form Number

Form Name

Revision Date
 

CHAPTER 2 FORMS

  
LA 2011 Application for Assignment as Fee Appraiser and Waiver Valuation Valuator 10/06
LA 20111 Jurisdictional Exception Certification and Standards 1,2, and 3 Checklists  
LA 2022B Appraisal Report 10/06
LA 2022C General Data 10/06
LA 2022D Subject Property Parcel Plat or Building Plan 10/06
LA 2022AF Waiver Valuation 08/06
LA 2022G Land Only Grid 10/06
LA 2022H Cost Approach - Value of Land or Special Land Improvements 10/06
LA 2022I Cost Approach - Principal Building Valuation 10/06
LA 2022J Cost Approach - Accessory Buildings 10/06
LA 2022K Sales Comparison Approach Improved Properties 10/06
LA 2022L Income Approach (Non-Farm) 10/06
LA 2022M Income Approach (Farm) 10/06
LA 2022N Conclusion of Value 10/06
LA 2022O Narrative Analysis of Taking 10/06
LA 2022P Narrative Analysis of Remainder and After Value Estimate 10/06
LA 2022Q Valuation of Easements 10/06
LA 2022R Summary of Taking 10/06
LA 2022S Additional Comments 10/06
LA 2022T Certificate of Appraiser 10/06
LA 2022U Comparable Sales Data 10/06
LA 2022V Comparable Rental Data 10/06
LA 2022Y Non-Complex Appraisal Report 10/06
LA 2022Z Neighborhood and Subject Property Description 10/06
LA 2022AB Narrative Explanation of Valuation 10/06
LA 2022AC Additional Comments 10/06
LA 2022AD Certificate of Appraiser 10/06
LA 2027A Certificate of Specialist 10/06
LA 20310 Appraiser Review Certification 10/06
 

CHAPTER 3 FORMS

  
LA 3013A Basis for Computing Approved Compensation and Offer to Purchase 09/18/07
LA 3013C Certification Form (1099-S Exemption) 10/06
LA 3013D Basis for Computing Approved Compensation and Offer to Purchase (Over $250,000) 09/18/07
LA 3013E Request for Approval to Purchase Property Over $250,000 10/06
LA 3014A Tenant-Owned Improvement Compensation and Offer to Purchase 10/06
LA 3014B Disclaimer Affidavit for Tenant-Owned Improvement 10/06
LA 3031 Application for Assignment as Negotiator 10/06
LA 30517 Offer to Purchase Uneconomic Remnant 10/06
LA 306 Negotiators Report 07/07
 

CHAPTER 4 FORMS

  
LA 4038 Corporate Resolution 02/29/08
LA 40312 Affidavit That Power of Attorney Is Still In Effect 02/19/08
LA 40315A Disclosure of Ownership Affidavit (Trust) 02/19/08
LA 40315B Disclosure of Ownership Affidavit Corporations, Partnerships, Limited Liability Companies) 02/19/08
LA 40315C Disclosure of Ownership Affidavit (Publicly Traded Company) 02/19/08
LA 4042 Application for Property Tax Exemption 02/19/08
LA 4051 Release of Surface Rights 02/19/08
LA 4052 Affidavit of Non-Production 02/19/08
LA 406A Subordination Agreement 03/21/08
LA 406B Subordination Agreement (Project) 03/21/08
LA 406C Freeway Release 03/21/08
LA 408A Warranty Deed (Individual) (Non-Freeway) 11/06/07
LA 408B Warranty Deed (Individual) Freeway 11/06/07
LA 408C Warranty Deed (Corporation) Freeway 03/21/08
LA 408D Warranty Deed (Corporation) Non-Freeway 03/21/08
LA 408D1 Warranty Deed - Limited Liability Company - Non-Freeway 03/21/08
LA 408D2 Warranty Deed - Limited Liability Company - Freeway 03/21/08
LA 408E Trustee's Deed (Corporation) Freeway 03/27/08
LA 408F Trustee's Deed (Corporation) Non-Freeway 03/27/08
LA 408G Trustee's Deed - Freeway 11/06/07
LA 408G1 Trustee's Deed With After Acquired Title Language - Freeway 03/27/08
LA 408H Trustee's Deed - Non-Freeway 11/06/07
LA 408H1 Trustee's Deed After Acquired Title Language – Non-Freeway 03/27/08
LA 408H2 Donation of Right-Of-Way Deed 11/06/07
LA 408I Dedication of Right-of-Way - Non-Freeway 03/27/08
LA 408J Dedication of Right-of-Way - Freeway 03/27/08
LA 408K Permanent Easement 02/29/08
LA 408L Permanent Easement (Railroad) 02/29/08
LA 408M Temporary Construction Easement 02/29/08
LA 408M1 Temporary Use Permit 02/29/08
LA 408N Scenic Easement 02/29/08
LA 408O Partial Release of Mortgage 02/19/08
LA 408P Completed Release of Mortgage (Corporation) 02/19/08
LA 408Q Completed Release of Mortgage (Individual) 02/19/08
LA 408R Release of Leasehold Interest (Tenant's Release of Lease) 03/18/08
LA 408S Special Warranty Deed (Corporation) Freeway 02/29/08
LA 408T Special Warranty Deed (Corporation) Non-Freeway 02/29/08
LA 408U Quitclaim Deed (Public Utility - Corporation) Freeway 02/29/08
LA 408V Quitclaim Deed (Public Utility - Corporation) Non-Freeway 02/29/08
LA 408W Quitclaim Deed 10/06
LA 408X Tenant's Consent to Temporary Easement 02/29/08
LA 408Y Mortgagee's Consent to Temporary Easement 02/29/08
LA 408Z Executor's Deed (Individual) 02/29/08
LA 408Z1 Executor's Deed (Corporation) 02/29/08
LA 408AA Release in Lieu of Waiver Of Damage Clause 03/27/08
LA 4091A Affidavit Of Title (No Unrecorded Interest, Etc.) 04/08/08
LA 4091B Operating Railroad Affidavit 03/18/08
LA 4092 Receipt for Warranty Deed 10/06
LA 4092A Receipt for Warranty Deed OVER $250,000 10/06
LA 4093 Closing Statement, Receipt for Deed and Designation of Funds 10/06
LA 4093A Closing Statement, Receipt for Deed and Designation of Funds Over $250,000 10/06
LA 4101A Affidavit Of Adverse Possession (20 Year) 03/17/08
LA 4101B Affidavit Of Adverse Possession (Color of Title) 03/17/08
LA 4102 Title Search Checklist 03/17/08
LA 414A Agreement with Utility Company to Acquire Substitute Right-Of Way 03/18/08
LA 414B Conveyance of Substitute Right-Of-Way to Utility Company 03/18/08
LA 415 Agreement to replace Property Acquired from a Public Agency 03/17/08
LA 4173 Standard Agreement Provisions - Joint Improvements of State Highway System 03/17/08
LA 4175 Standard Agreement Provisions - Joint Improvements of State Highway System - Federal Aid Right-Of-Way Projects 03/17/08
LA 4176A Project Compliance Checklist - Local Agency 03/13/08
LA 4176B Parcel Compliance Checklist - State Highway 03/13/08
LA 4176C Parcel Compliance Checklist - Relocation Assistance 03/13/08
LA 418 Crop Damage Report 03/13/08
LA 4181 Damage Release 03/13/08
LA 4182 Crop Damage Release 03/13/08
LA 420A Lessee's Release of Interest and Agreement to Vacate Advertising Sign 03/13/08
LA 420B Lessee's Release of Lease and Bill of Sale for Advertising Sign or Billboard 03/13/08
LA 4304 Authorization for Filing Quick Take Motion 03/13/08
LA 43012 Eminent Domain Checklist 03/13/08
 

CHAPTER 6 FORMS

  
LA 6019A Relocation Assistance Unit Record 03/07
LA 6019B Relocation Assistance Parcel Checklist 02/07
LA 6019C Uniform Act Relocation and Real Property Acquisition Statistical Report 02/07
LA 6023A Relocation Plan Interview - Residential 03/07
LA 6023B Relocation Plan Interview - Business 03/07
LA 6026 Notice of Receipt of Claim for a Relocation Payment 02/07
LA 6031B Bid Form for Actual Moving Expenses 02/07
LA 6031C Claim For Moving Expenses 04/07
LA 6032 Itemized Eligible Re-Establishment Expenses For Small Business, Farm and Non-Profit Organizations Worksheet 02/07
LA 6033A Request for Determination of Entitlement for Payment in Lieu Of Moving Expenses 02/07
LA 6033B Notice of Receipt For Determination of Entitlement for Payment in Lieu Of Moving Expenses 02/07
LA 6033C Claim for Fixed Payment in Lieu Of Moving Expenses 02/07
LA 6041A Replacement Housing Supplement Comparable Listing 02/07
LA 6041B Payment Evaluation Form for Replacement Housing Supplement - Purchase 02/07
LA 6041C Replacement Housing Supplement Certification 02/07
LA 6041E Mortgage Interest Differential Payments Computation Using HP-12C 02/07
LA 6041F Mortgage Interest Differential Payments Computation Using TIBA or EC-100 06/07
LA 6041G Claim for Replacement Housing Supplement 03/07
LA 6041H Dwelling Inspection - Decent, Safe and Sanitary 02/07
LA 6043A Payment Evaluation Form for Replacement Housing Supplement - Rent 02/07
LA 6043B Economic Mean Evaluation for Low Income Households 02/07
LA 606 Claim For Incidental Expenses for Acquired Property 02/07
LA 607 Application for Assignment as Relocation Agent 03/07/08

OUTDOOR ADVERTISING FORMS
LA 0001 Business Area Sign - Primary Highway 10/06
LA 0002 Business Area Sign - Interstate Highway 10/06
LA 0003 On-Premise Sign - Interstate Highway 10/06
LA 0004 For Sale or Lease Sign - Interstate Highway 10/06
LA 0005 Lodging, Food, Outdoor Recreation or Automotive Service Sign - Interstate Highway 10/06
LA 0006 Certificate - Individual 10/06
LA 0007 Certificate - Company 10/06

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