WPC  77WPC >?L A?@)?M)?MOw?)= ?N??O??B= <(^oZQ7>  (  (Untitled)'3,, , ,   UB ) 3    *    d +    d ,    d /0ghjklmnopqrstuvwxyz{|}~P* * c:\inf42\forms\ad424.wpf c:\product\forms\informs\ad424.wpfUS&&&&   >t?L f eh Terminal 1 ! d !  d      Terminal eb Arial " ! 2     d    Arial ev Times New Roman  ! 2 F  d    Times New Roman ez WP IconicSymbolsA  ! q !  d    WP IconicSymbolsA ez WP IconicSymbolsB  ! X# A  d    WP IconicSymbolsB ep Arial Narrow " ! &     d     Arial Narrow en Courier New 1 ! KL    d      Courier New ej Technical B ! ?    d     Technical e Times New Roman MT Extra Bold  ! ?    d    Times New Roman MT Extra Bold ex Helvetica-Narrow " ! &     d    Helvetica-Narrow eb Roman  ! 2    B    Roman eh Helve-WP " ! ?     d     Helve-WP ej Wingdings  ! } F  d     Wingdings eX  ! ? !  d     eh MS Serif  ! ? !  d     MS Serif ed Modern 2 ! 2    B    Modern ej Bodoni-WP  ! ? !  d     Bodoni-WP er MS Sans Serif " ! ? !  d    MS Sans Serif ed System " ! XS  d    System er CG Times (WN)  ! ? !  d    CG Times (WN) ef Courier 1 ! d !  d     Courier en Univers ATT " ! ? !  d     Univers ATT ep Times CG ATT  ! ? !  d     Times CG ATT e WPHelve-IconicSymbolsA " ! ?     d    WPHelve-IconicSymbolsA ex WP Arabic Sihafa  ! ?     d    WP Arabic Sihafa ?Ad A{?z jV c:\inf41\database\ AD424.DBFHISTORY   i$SSN     h SSN i%Name  8   h NAME8 i)RelocYes      h RELOCYES  i(RelocNo      h RELOCNO  i)ClaimYes      h CLAIMYES  i(ClaimNo      h CLAIMNO  i*MailAddr1     h MAILADDR1 i*MailAddr2     h MAILADDR2 i)OldStatn  +   h OLDSTATN+ i)NewStatn  +   h NEWSTATN+ i+DateTrnsfr     h  DATETRNSFR i+TrvlAuthNo  +   h  TRVLAUTHNO+ i+DateNStatn     h  DATENSTATN i(DateSrv     h DATESRV i(T_2[A1]  8   h T_2_A1_8 i(T_2[A2]  8   h T_2_A2_8 i(T_2[A3]     h T_2_A3_ i(T_2[A4]     h T_2_A4_ i(T_2[A5]     h T_2_A5_ i(T_2[A6]     h T_2_A6_ i(T_3[A1]  8   h T_3_A1_8 i(T_3[A2]  8   h T_3_A2_8 i(T_3[A3]     h T_3_A3_ i(T_3[A4]     h T_3_A4_ i(T_3[A5]     h T_3_A5_ i(T_3[A6]     h T_3_A6_ i*EmplSign1  (   h EMPLSIGN1( i*SignDate1     h SIGNDATE1 i*EmplSign2  (   h EMPLSIGN2( i*SignDate2     h SIGNDATE2 i+AsClaimed1      h  ASCLAIMED1  i*AsReduce1      h ASREDUCE1  i)SaleSign ! 9   h SALESIGN9 i*SaleTitle  "    h SALETITLE  i*SaleSDate #    h SALESDATE i+AsClaimed2  $    h  ASCLAIMED2  i*AsReduce2  %    h ASREDUCE2  i(BuySale & 9   h BUYSALE9 i)BuyTitle  '    h BUYTITLE  i)BuySDate (    h BUYSDATE i'Amount )    h AMOUNT i(AdmSign * H   h ADMSIGNH i)AdmTitle  +    h ADMTITLE  i)AdmSDate ,    h ADMSDATE i(T_4[D1] -    h T_4_D1_ i(T_4[C2] .    h T_4_C2_ i(T_4[C3] /    h T_4_C3_  i(T_4[C4] 0    h T_4_C4_ i(T_4[D4] 1    h T_4_D4_ i(T_4[D5] 2    h T_4_D5_ i(T_4[C6] 3    h T_4_C6_ i(T_4[D6] 4    h T_4_D6_ i(T_4[C7] 5    h T_4_C7_ i(T_4[D7] 6    h T_4_D7_ i(T_4[C8] 7    h T_4_C8_ i(T_4[D8] 8    h T_4_D8_ i(T_4[C9]" 9    h T_4_C9_" i(T_4[D9]# :    h T_4_D9_# i)T_4[C10]& ;    h T_4_C10_& i)T_4[D10]' <    h T_4_D10_' i)T_4[C11]* =    h T_4_C11_* i)T_4[D11]+ >    h T_4_D11_+ i)T_4[C12]. ?    h T_4_C12_. i)T_4[D12]/ @    h T_4_D12_/ i)T_4[C13]2 A    h T_4_C13_2 i)T_4[D13]3 B    h T_4_D13_3 i)T_4[C14]6 C    h T_4_C14_6 i)T_4[B15] 9 D    h T_4_B15_9  i)T_4[C15]: E    h T_4_C15_: i)T_4[D15]; F    h T_4_D15_; i)T_4[C16]> G    h T_4_C16_> i)T_4[D16]? H    h T_4_D16_? i)T_4[B18] E I    h T_4_B18_E  i)T_4[C18]F J    h T_4_C18_F i)T_4[D18]G K    h T_4_D18_G i)T_4[B19] I L    h T_4_B19_I  i)T_4[C19]J M    h T_4_C19_J i)T_4[D19]K N    h T_4_D19_K i)T_4[B20] M O    h T_4_B20_M  i)T_4[C20]N P    h T_4_C20_N i)T_4[D20]O Q    h T_4_D20_O i'Total1 R    h TOTAL1 i'Total2 S    h TOTAL2 ?@d @}?M#^81, d This form was electronically produced by Elite Federal Forms, Inc. > H!p0"0 #X$ C This form was  C electronically produced  C by Elite Federal Forms,  C Inc.                            <  &    ^% } SECTION A - EMPLOYEE O !"#                             P  &&    ^% } SECTION B - TRANSFER DATA O !"#                             P  &&    ^p% } SECTION C - RESIDENCE PROPERTY DATA O !"#                             P  &&    ^,%X 2 EMPLOYEE APPLICATION FOR REIMBURSEMENT OF EXPENSES INCURRED  2 UPON SALE OR PURCHASE (OR BOTH) OF RESIDENCE UPON CHANGE OF OFFICIAL STATION O !"#      P                       P      ^%^ &I See Privacy Act Notice On Reverse O !"#                             P  $    q^R, & A. EMPLOYEE  !"#                             P      h^,^ & 1.  !"#                             P      &0   & Obtain a copy of all supporting documents needed to file your claim.  & Include sales agreement between buyer and seller, settlement or loan  & closing statements, invoices and statements that support other items  & claimed for reimbursement, etc. Do not send your original supporting  & documents as they cannot be returned to you. Send photo copies only. $ !"#      P                       P      h^,^  & 2.   !"#                             P      &0^  & Prepare the front and back of this application in triplicate. Sign and date  & the appropriate employee certification(s).  $ !"#      P                       P      &f0 & Prepare Form AD-616R, Travel Voucher (Relocation).  $ !"#      P                       P      h^f, & 3.   !"#                             P      &. 0R & Submit the original and first copy of Form AD-424, all supporting  & documents, and the AD-616R, to the head of your office at new official  & station or to the appropriate official designated by your Department or  & agency. Retain the remaining copy of the AD-424 and supporting doc-  & uments for your records.  $ !"#      P                       P      h^. , & 4.   !"#                             P      w^ , & B. HEAD OF OFFICE  !"#                             P      h^ , & 1.  !"#                             P       & 0 &  For Sales. Submit the original and first copy of Form AD-424, all  & supporting documents, and the AD-616R, to the head of the office at the $ !"#      P                       P       |J0 & claimant's old official station as provided in Chapter 2, Part 6, of the  & Federal Travel Regulations (FTR). The approving official, or his/her  & designee, will handle and execute the approval and return the package to  & you (see Section D). -$ !"#      Z                       P      bJ0 &  For Purchases. Approval of this claim must be executed by the head of  & the office, or his/her designee, at the new official station (unless agency  & review and approval functions are performed elsewhere) (see Section D). -$ !"#      Z                       P      ?J40 &  Final Administrative Approval. Payment of the claim must be  & executed by an appropriate approving official (see Section E). Such  & official shall independently determine, in accordance with the provisions  & of the FTR, the propriety of all reimbursements claimed. In this  & connection, all vouchers for reimbursement of real estate incident to the  & same transfer shall be examined. Submit the approved AD-616R with  & attached original AD-424, and supporting documents, to the USDA,  & National Finance Center, P.O. Box 60,000. New Orleans, LA 70160.  & File the copy of the application with the office copy of the voucher. - $ !"#      Z                       P      h, & 2. + !"#                             P      h4, & 3. +  !"#                             P       V ^%#       P    ~^4X d 1. SOCIAL SECURITY NUMBER4 ,SSN!"-./56789:;>?@ABCG                         P #      $      '    Y@$.,! *  < && = &      V       P     V       P    s 6X d 2. NAME (Last, first, middle initial)6 ,Name!"-./567"89:";>?@ABCG                         P #      $      ' 8  Y@$.,! *  < && = &&     X  d 3. RELOCATION SERVICE  d PREVIOUSLY AUTHORIZED  d FOR THIS TRANSFER 7  !"#      Z                       P  &&    6X d  YES   RelocYes#"$%7&'()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (RelocNo)    RelocNo    6X d  NO   RelocNo##$%>&'()+,-.                             P   !  * & 1  2      3      "@RESETOBJ (RelocYes) !  RelocYes    rX$ d 4. HAS EARLIER CLAIM FOR  d REAL ESTATE EXPENSES BEEN  d SUBMITTED FOR THIS TRANSFER? C !"#      Z                       P  &&    r6X d  YES   ClaimYes#%$%C&'()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (ClaimNo)    ClaimNo    "6X d  NO   ClaimNo#&$%J&'()+,-.                             P   !  * & 1  2      3      "@RESETOBJ (ClaimYes) !  ClaimYes    ^0 ' d 5. MAILING ADDRESS (Street or P.O. Box, City, State, and Zip Code)   !"#                             P  &&     V^% (      P    ^%T 1 T_1#$(+),-.O/012456789                                    P ! %"u$%N&')*                      Y@$.,!  ( &&  3 &&    A     A     ?%N    4%MailAddr1")$%N&')*                      Y@$.,!  ( &&    4%MailAddr2"*$%N&')*                      Y@$.,!  ( &&    ]^P  d 6. OLD OFFICIAL STATION OldStatn!"-../56789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&     ?#?MO] P  d 7. NEW OFFICIAL STATION NewStatn! "-/./56789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&     wP  d 8. DATE OF NOTIFICATION OF IMPENDING TRANSFER DateTrnsfr! "-0./576789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&     k^  d 9. TRAVEL AUTHORIZATION NUMBER/DATE TrvlAuthNo! "-1./56789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&    |   d 10. DATE REPORTED FOR DUTY AT NEW OFFICIAL STATION DateNStatn! "-2./56789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&    h  d 11. DATE SERVICE AGREEMENT SIGNED DateSrv! "-3./576789:;>?@ABCG                         P #      $      ' +  Y@$.,! *  < && = &&     V^p% 4      P    ^8~X5 }& Complete  }&\ Address  }& of Residence   !"#      Z                       P  &    ^~6 q&: Number of Dwelling  q&l Units on Property "  !"#      Z                       P  &    ^ ~7 q& Sale and/or  q& Purchase Price $  !"#      Z                       P  &    ^~8 q& Date of Closing  q& or Settlement &  !"#      Z                       P  &    ^@~9 q&4 Amount of Expense  q& Being Claimed (  !"#      Z                       P  &    ^ ~: q  EMPLOYEE  q CERTIFICATION  q OF RESIDENCE  qm PROPERTY DATA *  !"#      Z                       P  x    j^Z#~,; X  -  !"#      Z                       P      8h< } 12. SALE (Old Official Station)   # !"#                             P  &&    D86= } 13. PURCHASE (New Official Station)  /" !"#                             P  &&    hT 2 T_2#$(H), - .#/ 012456789                                    P ! O"v$%!&')*                    8  Y@$.,!  ( &&  3 &&    A     A     A     A     A     A     ?h"    *h">$%"&')*                    8  Y@$.,!  ( &&     *h"@$%"&')*                    8  Y@$.,!  ( &&     *h"B$%"&')*                    8  A$.,!  ( &&     ,h"D$%"&')*                    8   $.,!  ( &&     ,h"F$%"&')*                    8  Y@$.,!  ( &&     ,h"I$%"&')*                    8   $.,!  ( &&     D6T 2 T_3#$(L),/- ."/ 012456789                                    P ! O"K$%!&')*                    8  Y@$.,!  ( &&  3 &&    A     A     A     A     A     A     ?6!    *6"M$%!&')*                    8  Y@$.,!  ( &&     *6"N$%!&')*                    8  Y@$.,!  ( &&     *6"O$%!&')*                    8  A$.,!  ( &&     ,6"P$%!&')*                    8   $.,!  ( &&     ,6"Q$%!&')*                    8  Y@$.,!  ( &&     ,6"R$%!&')*                    8   $.,!  ( &&      hS } I hereby certify that the amount claimed in connection with the above sale represents  } only amounts actually paid by me and that title to the property was in my name and/or  } a member of my immediate family and was my residence when first definitely informed of  } my transfer.  *# !"#      P                       P  &&     oD 6T } I hereby certify that the amount claimed in connection with the above purchase  } represents only amounts actually paid by me and that title to the property is in my  } name and/or a member of my immediate family and is my new residence. /*" !"#      U                       P  &&     _"  d 14. EMPLOYEE'S SIGNATURE EmplSign1!"-V./5 6,789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&    Q" d 15. DATE SignDate1!"-W./5%6,7 89: ;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&    _D"  d 14. EMPLOYEE'S SIGNATURE EmplSign2!"-X./5/6,789:;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&    Q!" d 15. DATE SignDate2!"-Y./5H6,7 89: ;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&    ^$%Z } SECTION D - APPROVALS .O !"#                             P  &&     V^$% [      P    ^-%\ } SECTION E - FINAL ADMINISTRATIVE APPROVAL FOR PAYMENT :O !"#                             P  &&     V^-% ]      P     X ^N%~ _      P    iN%h ` &   SALE EXPENSES.  The expenses of the sale applied for above are hereby  } approved as being (1) reasonable in amount and (2) customarily paid by a seller  } in the locality when the property is located.  /# !"#                             P  &&    oDN%6 a &   PURCHASE EXPENSES.  The expenses of the purchase applied for  } above are hereby approved as being (1) reasonable in amount and (2)  } customarily pay by a buyer in the locality when the property is located. //" !"#                             P  &&    ??) t' }&  18. As Claimed   AsClaimed1#b$% &2' ()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (RelocNo)    RelocNo     t'T  }&  19. As Reduced, Per Attached Memo   AsReduce1#c$%&2'()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (RelocNo)    RelocNo    Sn(hX d 20. SIGNATUREh ,SaleSign!"-e./5 637#89:#;>?@ABCG                         P #      $      ' 9  Y@$.,! *  < && = &&     P*h d 21. TITLE& SaleTitle!"-f./5 667#89:;>?@ABCG                         P #      $      '  9  Y@$.,!: *  < && = &&     QV,h d 22. DATEh SaleSDate!"-g./5 687#89:#;>?@ABCG                         P #      $      ' 9  Y@$.,! *  < && = &&     Dt' }&  23. As Claimed   AsClaimed2#h$%/&2' ()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (RelocNo)    RelocNo    Xt'"  }&  24. As Reduced, Per Attached Memo   AsReduce2#i$%:&2'()+,-.                             P   !  * & 1  2      3      !@RESETOBJ (RelocNo)    RelocNo    RDn(6X d 25. SIGNATURE6 ,BuySale!"-j./5/637"89:";>?@ABCG                         P #      $      ' 9  Y@$.,! *  < && = &&     OD*6 d 26. TITLE& BuyTitle!"-k./5/667"89:;>?@ABCG                         P #      $      '  9  Y@$.,!: *  < && = &&     PDV,6 d 27. DATE6 BuySDate!"-l./5/687"89:";>?@ABCG                         P #      $      ' 9  Y@$.,! *  < && = &&    P^..  d 29. AMOUNT. Amount!"-m./56;789:;>?@ABCG                         P #      $      '   !<6 !<6G$.,! *  < && = &     g^/^,n } $ < !"#                             P  &&     .o & Payment of this claim is approved in the amount indicated. If the amount approved is less than amount  & claimed, see the attached memo. ;; !"#      Z                       P  &    j .p q  ; !"#                             P  &&    R^>0 d 30. SIGNATURE AdmSign!"-q./56=7,89:,;>?@ABCG                         P #      $      ' H  Y@$.,! *  < && = &&    OD>0  d 31. TITLE& AdmTitle! "-r./5/6=789:;>?@ABCG                         P #      $      '  9  Y@$.,!: *  < && = &&     P!>0 d 32. DATE AdmSDate!!"-s./5H6=7 89: ;>?@ABCG                         P #      $      ' (  Y@$.,! *  < && = &&    81,t d FORM AD-424 (USDA) (Rev. 4/88) A? !"#                             P  &&    ?+= def =c?N^,%Xw 2 COSTS INCURRED AND PAID IN SELLING RESIDENCE AT OLD OFFICIAL STATION  2' OR PURCHASING RESIDENCE AT NEW OFFICIAL STATION LOCATION (OR BOTH) O !"#      P                       P      p^^x q* ITEM  !"#                             P       V ^%! y      P     V  z      P    y { q NEW RESIDENCE F  !"#                             P      |Xx| qT FORMER RESIDENCE :  !"#                             P      w} q EXPLANATION 4 !"#                             P       VX  ~      P     V         P    ^%@T 4 T_4#$(),-.O/(012456789                                    P ! G "$%&')*                       Y@$.,!  ( &&  3 &&    A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     A     ?^    ?3    ?x     ?     ?^ q&V 1."$%&')*      Z                  Y@$.,!  ( &&    I q& LOAN AMOUNT."$%3&')*      Z                  Y@$.,!  ( &&    0x"$% &')*                         $.,!  ( &<     ,"$% &')*                        $.,!  ( &<     O^ q&V 2.  q&  "$%&')*      Z                  Y@$.,!  ( &&    K q& BROKERAGE FEES. The sales commission paid to a broker or real estate agent for selling former residence. Also,  q& fees for listing a residence and payment for multiple listing service, if not included in commission paid to the broker  q& or agent."$%3&')*      U                  Y@$.,!  ( &&    ,x"$% &')*                        $.,!  ( x<     0"$% &')*                         $.,!  ( &<     @^ q&V 3. "$%&')*      Z                  Y@$.,!  ( &&     q& ADVERTISING: Expenses paid for newspaper and other advertising when a direct sale is made without the services  q& of a real estate broker or real estate agent "$%3&')*      Z                  Y@$.,!  ( &&    ,x "$% &')*                        $.,!  ( x<     0 "$% &')*                         $.,!  ( &<     @^ q&V 4.  "$%&')*      Z                  Y@$.,!  ( &&     q& APPRAISAL FEE: The amount paid to a professional appraiser for establishing a suggested sale price for the  q& residence. "$%3&')*      Z                  Y@$.,!  ( &&    ,x"$% &')*                        $.,!  ( x<     ,"$% &')*                        $.,!  ( x<     @^ q&V 5. "$%&')*      Z                  Y@$.,!  ( &&     q& LOAN ORIGINATION FEE: Amount charged to cover the administrative overhead cost of processing the loan.  q& (Subject to limitations contained in FTR 2--6.2d(1)(b).)."$%3&')*      Z                  Y@$.,!  ( &&    0x"$% &')*                         $.,!  ( &<     ,"$% &')*                        $.,!  ( x<     @^ q&V 6. "$%&')*      Z                  Y@$.,!  ( &&     q& SETTLEMENT FEE: Amount paid to escrow agent, title company, or similar entity for closing a real estate  q& transaction."$%3&')*      Z                  Y@$.,!  ( &&    ,x"$% &')*                        $.,!  ( x<     ,"$% &')*                        $.,!  ( x<     @^ q&V 7. "$%&')*      Z                  Y@$.,!  ( &&     q& ATTORNEY FEE: Searching title, preparing abstract and legal fees for a title opinion (does not include costs of  q& litigation)."$%3&')*      Z                  Y@$.,!  ( &&    ,x"$% &')*                        $.,!  ( x<     ,"$% &')*                        $.,!  ( x<     @^ q&V 8. "$%&')*      Z                  Y@$.,!  ( &&     q& TITLE INSURANCE POLICY: Owners coverage only on sale where customarily furnished; Lenders coverage only  q& on purchase when required by the lending institution."$%3&')*      Z                  Y@$.,!  ( &&    ,x"$% &')*                        $.,!  ( x<     ,"$% &')*                        $.,!  ( x<     @^ q&V 9.  "$%&')*      Z                  Y@$.,!  ( &&     q& CERTIFICATIONS: The amount paid for any required certifications as to structural soundness or physical  q& condition of property, when required by mortgagee-lender, FHA or VA (includes termite inspection fee).!"$%3&')*      Z                  Y@$.,!  ( &&    ,x""$% &')*                        $.,!  ( x<     ,#"$% &')*                        $.,!  ( x<     @^ q&7 10.$"$%&')*      Z                  Y@$.,!  ( &&    d q& LOAN APPLICATION FEE: The amount paid.%"$%3&')*      Z                  Y@$.,!  ( &&    ,x&"$% &')*                        $.,!  ( x<     ,'"$% &')*                        $.,!  ( x<     ???O@^ q&7 11.("$%&')*      Z                  Y@$.,!  ( &&    d q& STATE REVENUE STAMPS: The amount paid.)"$%3&')*      Z                  Y@$.,!  ( &&    ,x*"$% &')*                        $.,!  ( x<     ,+"$% &')*                        $.,!  ( x<     A^ q&7 12. ,"$%&')*      Z                  Y@$.,!  ( &&     q& CREDIT REPORT: The amount paid for credit or factual data report on the buyer, if required by mortgagee/lender,  q& FHA or VA.-"$%3&')*      Z                  Y@$.,!  ( &&    ,x."$% &')*                        $.,!  ( x<     ,/"$% &')*                        $.,!  ( x<     A^ q&7 13. 0"$%&')*      Z                  Y@$.,!  ( &&     q& RECORDING FEES AND RECORDING TAXES: Other charges paid incident to recordation (e.g., mortgage  q& discharge recording fees).1"$%3&')*      Z                  Y@$.,!  ( &&    ,x2"$% &')*                        $.,!  ( x<     ,3"$% &')*                        $.,!  ( x<     P^ q&7 14.  q&  4"$%&')*      Z                  Y@$.,!  ( &&    Z q& PREPAYMENT CHARGE: The amount paid as required in the mortgage or other security instrument as a charge  q& for prepayment; or if not specifically required by the mortgage instrument, the amount paid limited to 3 months  q& prevailing interest on the loan balance.5"$%3&')*      U                  Y@$.,!  ( &&    ,x6"$% &')*                        $.,!  ( x<     07"$% &')*                         $.,!  ( x<     @^ q&7 15.8"$%&')*      Z                  Y@$.,!  ( &&    *9"$%3&')*      Z                  Y@$.,!@  ( X&     ,x:"$% &')*                        $.,!  ( x<     ,;"$% &')*                        $.,!  ( x<     @^ q&7 16.<"$%&')*      Z                  Y@$.,!  ( &&    } q& SALES OR TRANSFER TAXES; MORTGAGE TAX, IF ANY: The amount paid.="$%3&')*      Z                  Y@$.,!  ( &&    ,x>"$% &')*                        $.,!  ( x<     ,?"$% &')*                        $.,!  ( x<     O^ q&J 17  q&  @"$%&')*      Z                  Y@$.,!  ( &&    0 q& OTHER INCIDENTAL EXPENSES: Such other reasonable and customary charges or fees paid as may be  q& authorized and not properly includable in items listed above (itemize and explain; if necessary, attach separate  q& sheet).A"$%3&')*      U                  Y@$.,!  ( &&    0xB"$% &')*                         $.,!  ( x<     0C"$% &')*                         $.,!  ( x<     ,^D"$%&')*      Z                  Y@$.,!  ( &&    *E"$%3&')*      Z                  Y@$.,!@  ( &&     ,xF"$% &')*                        $.,!  ( x<     ,G"$% &')*                        $.,!  ( x<     ,^H"$%&')*      Z                  Y@$.,!  ( &&    *I"$%3&')*      Z                  Y@$.,!@  ( &&     ,xJ"$% &')*                        $.,!  ( x<     ,K"$% &')*                        $.,!  ( x<     ,^L"$%&')*      Z                  Y@$.,!  ( &&    *M"$%3&')*      Z                  Y@$.,!@  ( &&     ,xN"$% &')*                        $.,!  ( x<     ,O"$% &')*                        $.,!  ( x<     gX,, } $ : !"#                             P  &&    gX:,, } $ :  !"#                             P  &&    gX,, } $ :  !"#                             P  &&    g ,, } $ F  !"#                             P  &&    g Z ,, } $ F  !"#                             P  &&    g  ,, } $ F !"#                             P  &&    g z ,, } $ F !"#                             P  &&    g  ,, } $ F !"#                             P  &&    g ,, } $ F !"#                             P  &&    g *,, } $ F !"#                             P  &&    g ,, } $ F !"#                             P  &&    g J,, } $ F !"#                             P  &&    g ,, } $ F !"#                             P  &&    gX ,, } $ : !"#                             P  &&    gXz ,, } $ : !"#                             P  &&    ??BgX ,, } $ : !"#                             P  &&    gX,, } $ : !"#                             P  &&    gX*,, } $ : !"#                             P  &&    gX,, } $ : !"#                             P  &&    gXJ,, } $ : !"#                             P  &&    gX,, } $ : !"#                             P  &&    gXj,, } $ : !"#                             P  &&    gX,, } $ :! !"#                             P  &&    gX,, } $ :# !"#                             P  &&    g ,, } $ F! !"#                             P  &&    g ,, } $ F# !"#                             P  &&    gX,, } $ :' !"#                             P  &&    gX: ,, } $ :) !"#                             P  &&    gX!,, } $ :+ !"#                             P  &&    g ,, } $ F' !"#                             P  &&    g : ,, } $ F) !"#                             P  &&    g !,, } $ F+ !"#                             P  &&    mR q& SURVEY:   !"#                             P  &&    q^" & TOTAL ,7 !"#                             P  &    7X"xx Total1!"-./5:6,7 89: ;>?@ABCG                         P #      $      '    $.,! *  < && = x<     :@sum(T_4[C2..C4],T_4[C6..C16],T_4[C18..C20])  T_4  T_4>  T_4FN    k  gXZ#,, } $ :- !"#                             P  &&    7 " Total2!"-./5F6,7 89: ;>?@ABCG                         P #      $      '    $.,! *  < && = x<     D@SUM(T_4[D1],T_4[D4..D13],T_4[D15..D16],T_4[D18..D20])  T_4  T_43  T_4;?  T_4GO    k  g Z#,, } $ F- !"#                             P  &&    j,#, 7  7- !"#                             P  &&    o", d 1] and 3] A, !"#                             P  &    o$", d 2] and 3] M, !"#                             P  &    T^$N%R &  Note: In accordance with the real estate expense provisions of the Federal Travel Regulations, costs of insurance against damage or loss of  & property, maintenance and operating costs and property taxes are not reimbursable. Also, mortgage discounts, points, interest on loans, and  & losses in connection with the sale or purchase of a residence due to price or market conditions are not reimbursable. Notwithstanding the  & above, no fee, cost, charge, or expense is reimbursable which is determined to be a part of the finance charge under the Truth in Lending Act,  & Title I, Public Law 90-321 and Regulation Z issued pursuant thereto by the Board of Governors of the Federal Reserve System. .O !"#      U                       P      X^V,N% &  Privacy Act Notice. The following information is provided to comply with the Privacy Act of 1974 (P.L. 93"579). The information requested  & on this form is required under the provisions of 5 USC, Chapter 57 (as amended) and Executive Orders 11609 of July 22,1971, and 11012 of  & March 27, 1962, for the purpose of recording travel expenses incurred by the employee and to claim other entitlements and allowances as  & prescribed in the Federal Travel Regulations (41 CFR 101"7). The information contained in this form will be used by Federal Agency officers  & and employees who have a need for such information in the performance of their duties. Information will be transferred to appropriate Federal,  & State, local or foreign agencies, when relevant to civil, criminal, or regulatory investigations or prosecutions or pursuant to a requirement by  & GSA or such other agency in connection with the hiring or firing, or security clearance, or such other investigations of the performance of  & official duty in Government service. Failure to provide the information required will result in delay or suspension of the employee's claim for  & reimbursement. 8O !"#      U                       P      ("$ & The aggregate amount of expenses which may be reimbursed is the amount which should not exceed 10% of sale price or the maximum  & allowances as stated in FTR 2-6.2.g. 4M !"#      U                       P      p^'4 & Footnotes: 3 !"#                             P      )"$ & The aggregate amount of expenses which may be reimbursed is the amount which should not exceed 5% of purchase price or the maximum  & allowances as stated in FTR 2-6.2.g. 5M !"#      U                       P      \+"$, & If property is multiple family unit type (excluding condominium), expenses will be prorated and allowed for residence unit only. 7M !"#      Z                       P      h^(&^ & 1] 4 !"#                             P  &    h^)&^ & 2] 5 !"#                             P  &    h^\+&^ & 3] 7 !"#                             P  &    ?= d e f =o<(defg h <F^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=ZeީXZ