Project No.:	enter text	Project ID:	enter text
Designation:	enter text	Sign or Parcel No:	enter text
Sign Owner:	enter text	Sign Owner Address:	enter text
Phone Number:	enter text
Location:	enter text	Advertiser:	enter text

Date Taken:	choose a date	Taken By:	enter text
Taken From:	enter text	Facing:	enter text
Remarks:	enter text

FEATURES	DESCRIPTION
Land-Owner Name	enter text
Address	enter text
Phone Number:	enter text
Sign Permit Number	enter text
Date Owner Contacted:	enter text
Date of Inspection	enter text
Dimensions	enter text
Materials	enter text
Lights	enter text
Location of power source	enter text
Catwalk	enter text
Type of Post	enter text
Age of Sign	enter text
Single or double-faced	enter text
Other (cutouts, apron, etc.)	enter text

Describe Condition of Sign
Structure	enter text
Stringers, braces, panels, platform or molding need repair?	enter text
Lights damaged?	enter text
Copy faded, chipped, cracked, peeling, needs paint, missing message?	enter text
Overall condition	enter text

DEPRECIATION (physical deterioration and / or functional obsolescence): Select the appropriate percentage of depreciation to apply to the estimated cost new.
0%	Maintained in excellent condition. No obsolescence. Low risk of changed use.
5-10%	Sound structure, minor deterioration; new use probable in 12-15 years
15-30%	Deferred maintenance. Parts need replacement. Risk of changed use in 8-11 years
35-50%	Advanced deterioration, large areas of rust or rot. Several components need replacement. Neighborhood redevelopment expected in the next 5-7 yrs.
55-70%	Structure may be unsound; could be repaired; Most of the components need replacement. Neighborhood redevelopment expected in the next 2-4 years.
75-90%	Structure needs to be replaced. May be some salvage value. Structure is obsolete or view is obstructed. Site changing use within the next year.

VALUATION
Cost to Remove and Reset sign (if it can be moved to a conforming location – attach contactor estimate)	$enter text
(B) Administration and Oversight fee (A x 0.05 or $1,000, whichever is lower)	$enter text
(C) Total cost to remove and reset sign (A + B)	$enter text
(D) Replacement Cost New (attach contractor estimate)	$enter text
(E) Depreciation percentage from above schedule	enter text%
(F) Depreciation (D x E)	$enter text
(G) Total cost to purchase sign (D – F)	$enter text
(H) Compensation for Sign (Lesser of C or G) *	$enter text
(I) Total Compensation Rounded	$enter text

The sign valuations will be calculated using form MDT-ROW-481. District ROW Supervisors will review and approve form MDT-ROW-481 when the value is less than $15,000. When the value exceeds $15,000, a Review Appraiser must review and approve MDT-ROW-481. If conclusion is to purchase the sign, Reviewer or District Supervisor shall notify the Land Appraiser to consider including compensation for the lost sign site in the land appraisal using sign site valuation (form MDT-ROW-480). If the conclusion is to purchase the sign, the Reviewer or District Supervisor shall notify the Land Appraiser to consider including compensation for the lost sign site in the land appraisal using sign site valuation (form MDT-ROW-480).

ELECTRONIC SIGNATURE CONSENT

By my signature/typewritten name, I declare under penalty of perjury and the laws of the State of Montana that the foregoing is true and correct and contains no willful falsifications or misrepresentations.

Prepared by:

Signature (Typed Name)	Date	Place of Signature (City, State)
Choose a date

Approved by Special Programs Supervisor (if conclusion is to remove & reset the sign)

Signature (Typed Name)	Date	Place of Signature (City, State)
Choose a date

Approved by Review Appraiser when value is over $10,000 or District Supervisor under $10,000: