Laserfiche WebLink
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION <br />CERTIFICATE OF OCCUPANCY AND RECEIPT <br />OF RELOCATION INFORMATION <br />DOT RW 10-25 (REV 09/2023) <br />PERSONAL INFORMATION NOTICE <br />This form requests personal information. Disclosure of this information is voluntary. The principal purpose of the request for personal Information is to facilitate <br />IsProcessing this form. Failure to provide all or any part of the requested information may delay processing of this form. The California Department of Transportation <br />"committed to the privacy of your personal information. Our policies regarding personal information collected and managed by our department are governed by <br />law, including the Information Practices Act of 1977 (Civil Code Section 1798 and following), <br />DIST CO RTE KIP (P.M.) - EXP AUTH <br />08 SBD 038 11.8 1K860 <br />AR PARCEL NO. FEDERAL PROJECT NO. <br />25960 25960-1 N/A <br />To Relocation Advisor: <br />• I have received the Department of Transportation's Relocation <br />Information Brochure, Information Letter and Postcard. <br />• I will file my claim for any benefits due mein accordance with the <br />instructions as set forth in the Brochure. <br />I certify that the following information is true to the best of my <br />knowledge. <br />Number of Occupants <br />No person displaced. <br />I (We) first occupied the property (to be) <br />acquired by the State on: <br />OCCUPANT'S NAME SIGNATt� OWN <br />THE CITY OF REDLANDS, A MUNICIPAL CORPORATION // <br />ADDRESS DATKJ <br />SW c/o Mentone Blvd and Agate Avenue <br />Mentone, CA 92359 <br />APN: 0298-181-08 <br />I have personally verified the above occupancy and I certify possession of: <br />Bedroom(s) <br />Living room <br />Dining room <br />Den <br />Kitchen <br />Service porch <br />Garage <br />Other <br />Total room count <br />Date of State's first offer to acquire this property: <br />06/1912024 <br />❑ Non residential <br />❑ No personal property to be moved <br />❑ Personal property only; <br />furniture owned by <br />❑ Tenant [Frowner. <br />Right of Way Agent <br />ADA Notice This document Is available in alternative accessible formats. For more information, please contact the Forms Management Unit at (279) 234-2284, <br />TTY 711, in writing at Forms Management Unit, 1120 N Street, MS-89, Sacramento, CA 95814, or by email at Forms.Management.Unit@dot.ca.gov. <br />