Free DT1783 Vacancy Notice - Wisconsin

Clear Form

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

E-mail Form

Save Form

Print Form