Fill and Sign the Deville Apartments Amp Builders Rental Application Form

DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO. 1660-0004 Expires March 31, 2011 APPLICATION FOR PARTICIPATION IN THE NATIONAL FLOOD INSURANCE PROGRAM PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 4 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing, and submitting the form. You are not required to submit to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20472, and Paperwork Reduction Project (1660-0004). NOTE: Do not send your completed form to this address. DATE 1. APPLICANT COMMUNITY NAME (City, town, etc.) COUNTY, STATE 2. COMMUNITY OFFICIAL - CHIEF EXECUTIVE OFFICER (CEO) E-MAIL ADDRESS TELEPHONE NO. (Include area code) E-MAIL ADDRESS TELEPHONE NO. (Include area code) ADDRESS (Street or box no. city, state, zip code) 3. PROGRAM COORDINATOR (Official, if different from above, with overall responsibility for implementing program) ADDRESS (Street or box no., city, state, zip code) LOCATION OF COMMUNITY REPOSITORY FOR PUBLIC INSPECTION OF NFIP MAPS ADDRESS 5. ESTIMATES FOR THOSE AREAS PRONE TO FLOOD AND/OR MUDSLIDE AS OF THE DATE OF THIS APPLICATION AREA IN ACRES NO. OF 1-4 FAMILYSTRUCTURES POPULATION NO. OF ALL OTHER STRUCTURES 6. ESTIMATES OF TOTALS IN ENTIRE COMMUNITY NO. OF 1-4 FAMILYSTRUCTURES POPULATION NO. OF ALL OTHER STRUCTURES 7. FOR FEMA REGIONAL USE ONLY 1. FEMA REGIONAL OFFICE 2. NAME OF CONTACT 3. TELEPHONE NO. 4. LEVEL OF 44 CFR 60.3 REGULATION ADOPTED (Check one) 60.3 60.3(b) 60.3(c) 60.3(d) 5. CHECK APPROPRIATE BOX: 60.3(e) EMERGENCY PHASE REGULAR PHASE IF REGULAR PROGRAM, SPECIFY FIRM INDEX DATE. IF USING ANOTHER COMMUNITY'S FIRM, GIVE COMMUNITY NAME, CID, FIRM INDEX DATE AND MAP PANEL NUMBER DEPICTING COMMUNITY FEMA Form 81-64, MAR 08