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VACANCY NOTICE
DT1783 2/2009 (Replaces RE4021) Ch. 32.19 Wis. Stats.
Wisconsin Department of Transportation
Name/Relocatee
Subject Property Address
Type of Dwelling/Structure Subject Site
Choose One Owner Tenant
New Address
New Phone
E-mail Address Gas Company Electric Company
I have vacated the subject property, removed all personal property and notified the Utility Companies to change the service to WISDOT. Remarks:
Relocatee Signature
Date
Date subject site vacated Date of physical inspection Keys Received Yes All personal property has been removed to the satisfaction of WISDOT. Remarks: No
Real Estate Specialist Project ID County
Date Parcel
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