<table>
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<tbody>
<tr class="odd">
<td colspan="4"><p><img src="media/image1.wmf"
style="width:0.41597in;height:0.41597in" /></p>
<p>U.S. Department of Transportation</p>
<p>Federal Aviation Administration</p></td>
<td colspan="19"><p><strong>Schedule B</strong></p>
<p><strong>Direct Loss of or Purchase of Substitute Personal
Property</strong></p>
<p><strong>(49 CFR 24.301 (g)(14)(15)(16))</strong></p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="11"><strong>1. Claimant Name:     </strong></td>
<td colspan="12"><strong>2. Project/Parcel:     /     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23"><p><strong>3. Claim of Direct Loss of Tangible Personal
Property:</strong></p>
<p><em><strong>LESSER OF: Direct Loss (i.e. Value-in-Use/Cost of Goods
Inventory/Substitute Cost less Sales proceeds)</strong></em></p>
<p><em><strong>or</strong></em></p>
<p><em><strong>Agency's Accepted Estimated Moving Cost to Relocate
Item(s)</strong></em></p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="10"></td>
<td colspan="8"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>Item not moved or replaced, or item replaced by
substitute item at replacement site.</strong></td>
<td colspan="6"><p><strong>Value for Continued Use/ Cost of
Goods/</strong></p>
<p><strong>Substitute Cost of Item</strong></p>
<p><strong>Installed</strong></p></td>
<td colspan="2"><p><strong>Proceeds from Sale of Item</strong></p>
<p><em><strong>(As Is Sold On-site for Removal )</strong></em></p></td>
<td colspan="4"><strong>Net Loss</strong></td>
<td colspan="3"><p><strong>Estimated Moving Cost</strong></p>
<p><strong>(Provided by Agency)</strong></p></td>
<td colspan="4"><strong>Amount Claimed</strong></td>
<td colspan="2"><strong>For Agency Use Only</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>1.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>2.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>3.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>4.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>5.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>6.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>7.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>8.      </strong></td>
<td colspan="6">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><strong>9.      </strong></td>
<td colspan="5">     </td>
<td colspan="2">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td colspan="4">$0.00</td>
<td colspan="3">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="14"><strong>Plus Cost of Sale (advertising, display,
etc.)</strong></td>
<td colspan="2">     </td>
<td colspan="4">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="12"></td>
<td colspan="7"><strong>Total Amount Claimed</strong></td>
<td colspan="4">$0.00</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23">6. Comments      </td>
<td></td>
</tr>
<tr class="even">
<td colspan="23"><p><strong>RELEASE:</strong> I (We) hereby release any
and all interest, ownership and title to personal property remaining on
the acquired site for which eligible payment for direct loss of or
substitute of personal property not relocated is or will be claimed.</p>
<p><strong>Signature Date Signature Date</strong></p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23"><strong>Section II - To Be Completed by
Agency</strong></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="2"><p>Recommended</p>
<p><strong>THIS</strong></p>
<p><strong>CLAIM</strong></p></td>
<td colspan="5"><strong>Amount</strong></td>
<td colspan="12"><strong>Name - Signature</strong></td>
<td colspan="4"><strong>Title</strong></td>
<td><strong>Date</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5">     </td>
<td colspan="12">     </td>
<td colspan="4">     </td>
<td>     </td>
<td></td>
</tr>
<tr class="even">
<td><strong>Approved</strong></td>
<td colspan="5">     </td>
<td colspan="12">     </td>
<td colspan="4">     </td>
<td>     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="23"> END - SAVE/NEXT FORM</td>
<td></td>
</tr>
</tbody>
</table>