Nebraska Department of Transportation

Disposition Request

(to be completed by requesting District)

1.) Yard Name:	Yard No.:

2.) Requesting District:	3.) Date Requested:
District Contact:	Expected Disposition Date:
Phone No.:

4.) Disposition Justification:
5.) Potential Interested Parties: (attach additional paper if needed)
Interested Party: Phone No.: Was Contact Made: By Whom:	Interested Party: Phone No.: Was Contact Made: By Whom:
6.) Comments: (Include known environmental concerns, fuel storage, etc.)

7.) District Engineer Approval:

Signature	Date

8.) Forward to Operations Manager for Approval, cc NDOT Capital Facilities Dispositions Email Group

Signature	Date

9.) Forward Completed Form to ROW Property Management, cc NDOT Capital Facilities Dispositions

NDOT Form 93, October 2017