CDOT Form 440 "Replacement Housing Payment Claim" - Colorado

What Is CDOT Form 440?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 440 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 440 "Replacement Housing Payment Claim" - Colorado

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Project Code:
COLORADO DEPARTMENT OF TRANSPORTATION
Parcel No:
REPLACEMENT HOUSING
Project No:
PAYMENT CLAIM
Location:
County:
Claimant’s name:
State acquired property address or location (include apt. # or mobile home space #):
Replacement property address or location (include apt. # or mobile home space #):
180 Day Homeowner Occupant:
a) Replacement dwelling price ....................................................... $
b) Comparable dwelling price ....................................................... $
c) Acquired property price paid by state ......................................... $
d) Price differential ............................................................................................... $
e) Increased mortgage interest costs ................................................................... $
f) Incidental expenses ......................................................................................... $
g) Rental assistance payment for 180 day homeowner ........................................ $
NOTE: If the replacement housing payment (price differential, increased mortgage, and incidental
expenses) is greater than the statutory limit of $22,500 then the price differential amount must be
applied to the purchase price of the replacement dwelling.
90 Day Occupant (owner or tenant):
a) Monthly rent (including utilities) required to obtain replacement $
b) Computation based on the lesser of one of the following:
1) Rent (including utilities) ........................................................ $
2) 30% of the total monthly gross household income .............. $
3) Amount designated for shelter and utilities for
government assistance ....................................................... $
c) The rental differential ................................................................ $
d) Rental assistance payment (rental differential X 42 months) ........................... $
e) Downpayment (including incidental expenses) ................................................ $
Less than 90 Day Occupant (owner or tenant) – Housing of Last Resort
a) Monthly rent (including utilities) required to obtain replacement $
b) 30% of the total monthly gross household income .................... $
c) The rental differential ................................................................ $
d) Rental assistance payment (rental differential X 42 months) ........................... $
e) Downpayment (including incidental expenses) ................................................ $
NOTE: If the rental assistance payment is greater than the statutory limit of $5,250 then payment will be
disbursed in 3 installment payments at 14 month intervals. The full amount of the downpayment must
be applied to the purchase price of the replacement dwelling and related incidental expenses.
I certify that all information submitted herewith is true and correct, that I have or will occupy a
replacement dwelling which is decent, safe and sanitary before I accept any payment, and that I have
not submitted any other claim for or received payment of any compensation for the benefit claimed
herein as shown above.
Claimants signature(s)
Date:
Date:
To be completed by CDOT
I certify that to the best of my knowledge the amount of payment is correct and that this claim conforms
in all respects to the applicable provisions of State law.
Real Estate Specialist signature
Date:
Statewide ROW Program Manager (review & approval)
Date:
05/17
CDOT Form #440
cc: Project Development Branch, ROW Services (original)
Region ROW
Previous editions are obsolete and my not be used
Project Code:
COLORADO DEPARTMENT OF TRANSPORTATION
Parcel No:
REPLACEMENT HOUSING
Project No:
PAYMENT CLAIM
Location:
County:
Claimant’s name:
State acquired property address or location (include apt. # or mobile home space #):
Replacement property address or location (include apt. # or mobile home space #):
180 Day Homeowner Occupant:
a) Replacement dwelling price ....................................................... $
b) Comparable dwelling price ....................................................... $
c) Acquired property price paid by state ......................................... $
d) Price differential ............................................................................................... $
e) Increased mortgage interest costs ................................................................... $
f) Incidental expenses ......................................................................................... $
g) Rental assistance payment for 180 day homeowner ........................................ $
NOTE: If the replacement housing payment (price differential, increased mortgage, and incidental
expenses) is greater than the statutory limit of $22,500 then the price differential amount must be
applied to the purchase price of the replacement dwelling.
90 Day Occupant (owner or tenant):
a) Monthly rent (including utilities) required to obtain replacement $
b) Computation based on the lesser of one of the following:
1) Rent (including utilities) ........................................................ $
2) 30% of the total monthly gross household income .............. $
3) Amount designated for shelter and utilities for
government assistance ....................................................... $
c) The rental differential ................................................................ $
d) Rental assistance payment (rental differential X 42 months) ........................... $
e) Downpayment (including incidental expenses) ................................................ $
Less than 90 Day Occupant (owner or tenant) – Housing of Last Resort
a) Monthly rent (including utilities) required to obtain replacement $
b) 30% of the total monthly gross household income .................... $
c) The rental differential ................................................................ $
d) Rental assistance payment (rental differential X 42 months) ........................... $
e) Downpayment (including incidental expenses) ................................................ $
NOTE: If the rental assistance payment is greater than the statutory limit of $5,250 then payment will be
disbursed in 3 installment payments at 14 month intervals. The full amount of the downpayment must
be applied to the purchase price of the replacement dwelling and related incidental expenses.
I certify that all information submitted herewith is true and correct, that I have or will occupy a
replacement dwelling which is decent, safe and sanitary before I accept any payment, and that I have
not submitted any other claim for or received payment of any compensation for the benefit claimed
herein as shown above.
Claimants signature(s)
Date:
Date:
To be completed by CDOT
I certify that to the best of my knowledge the amount of payment is correct and that this claim conforms
in all respects to the applicable provisions of State law.
Real Estate Specialist signature
Date:
Statewide ROW Program Manager (review & approval)
Date:
05/17
CDOT Form #440
cc: Project Development Branch, ROW Services (original)
Region ROW
Previous editions are obsolete and my not be used