Fillable SF429A Real Property Report (Northern Border Regional Commission)

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SF429A Real Property Report (Northern Border Regional Commission)

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U.S.A. forms for Northern Border Regional Commission

BROWSE NORTHERN BORDER REGIONAL COMMISSION (NH) FORMS

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Real Property Status Report
ATTACHMENT A (General Reporting) SF-429-A
OMB Number: 4040-0016
Expiration Date: 01/31/2019
Federal Grant or Other Identifying Number Assigned
by Federal Agency (#2 on cover page)
Complete the applicable blocks below for each parcel of real property being reported (duplicate this page to provide information for each
parcel of real property being reported under the Federal financial assistance award identified in section 2):
13. Period and type of Federal Interest (MM/DD/YYYY):
To:
From:
Acquisition
Renovation
Construction
14a. Description of Real Property:
14b. Address of Real Property (legal description and complete address including zoning information):
Street1:
Street2:
City:
State:
ZIP / Postal Code:
Country:
County:
Province:
Zoning Information:
GPS Location Longitude:
GPS Location Latitude:
14c. Land Acreage or Square Units:
Enter Amount:
Select units:
Acres
Square Kilometers
Square Feet
Square Meters
14d. Gross and Usable Square Footage/Meters (i.e., of building, house, etc.):
Enter Amounts:
Gross
Usable
Square Meters
Square Feet
Select units:
14e. Real Property Ownership Type(s):
A. Owned
D. Corporate
B. Co-Owned
E. Joint Tenancy
C. Fee Simple
F. Partnership
G. Limited Liability Partnership
H. Co-Operative
I. Government Furnished Property
J. Other (Describe):
14f. Real Property Cost:
Federal Share:
$
[
%]
$
Share Percentage %:
Non-Federal Share:
$
[
%]
Total (sum of Federal and Non-Federal Share):
$
[
%]
14g. Has a deed, lien, covenant, or other related documentation been recorded to establish Federal interest in this real property?
Yes
No
N/A
If yes (unless previously reported), describe the instrument used and enter the date and jurisdiction in which it was recorded:
Date:
Jurisdiction:
14h. Has Federally required insurance coverage been secured for this real property?
Yes
No
See instructions for more details.
14i. Are there any Uniform Relocation Act (URA) requirements applicable to this real property?
Yes
No
14j. Are there any environmental compliance requirements related to the real property?
Yes
No
If yes, describe them:
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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?
Yes
No
If yes, describe them:
15. Has a significant change occurred with the real property, or is there an anticipated change expected during the next reporting period?
Yes
No
If yes, describe the change:
16. Real Property Disposition Status:
A. Sold
C. Used in other Federally sponsored project/program
D. Transferred title
E. Retained Title
F. N/A
i. 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:
ii. If applicable, enter the amount of any net proceeds from the sale of the real property and describe how
the proceeds were distributed:
iii. If the Federal agency directed the recipient to transfer title to the real property, enter the amount of
funds the Federal Agency owes:
B. Transferred to different award
17. Indicate the cumulative energy consumption for the previous 12 months:
A. Electric (kWh)
or (Btu)
B. Petroleum (Gal)
C. Natural Gas (cu ft)
D. Other
(Specify)
18. Remarks:
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SF429A Real Property Report (Northern Border Regional Commission)

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Completed 26 January 2021

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