Printing - FECA-PT2 - National Association of Letter Carriers

By signing this agreement, all parties indicate an understanding of and agreement with the conditions set
forth above regarding the housing modifications to be completed at ADDRESS.
_______________________________________
Claimant
CLAIMANT NAME
_______________________________________
Co-owner(s) of the home (if applicable)
CO-OWNER’S NAME
_______________________________________
Claimant’s Representative (if applicable)
REPRESENTATIVE’S NAME
Agreement Prepared By:
Name:
Title:
Date:
2-1800-Exhibit 3 (Rental Property Modification)
Date: ___________
Date: ___________
Date: ___________
Memorandum of Agreement – Modification to Rental Property
(Office of Workers’ Compensation Programs and Claimant)
This agreement establishes the parameters under which the Office of Workers’ Compensation Programs
(OWCP) agrees to pay for the modification of an apartment to be used as your primary residence. The
apartment at ADDRESS is a # bedroom, # bath unit with # square feet. The initial length of lease will be
# years.
The undersigned agrees to the following:
FECA-PT2 Printed: 06/08/2010 731