Project ID:	enter text	Project No.:	enter text
Designation:	enter text	Parcel No.:	enter text
Landowner:	enter text

We, the undersigned, hereby and herein expressly disclaim any right, title, interest or estate in or to the following described property:

DESCRIPTION OF IMPROVEMENTS	LESSEE

enter text	enter text

The undersigned hereby authorize the Department of Transportation to negotiate with Lessees (or others) and to compensate them directly for the improvements described above.

Signature	Date

Signature	Date