Insert date of completion.

Section 1, Property Location:

Name: May be current owner, proposed owner or both.

Route: Be complete ie, 1234 county route 113, River Road

Phone: Optional

Tax map No.: Must be complete and accurate; Section, Block and Lot, 124.2-2-24.5

Other: May be used for approximate distances from intersections etc.

Section 2, This section details the notification of action being taken.

Section 3, This section advises the consumer how a positive flood hazard determination was made and if it was made based upon property location or structure location.

Serction 4, This section provides important information to be disclosed to the consumer. It advises them that a positive determination made by a lender, insurance, real estate or other professional may not be 100% accurate and that federal appeals procedures are available which may afford relief for their particular situation.

Section 5, Complete so that you can be notified by mail or phone should the status of a property and/or structure change with the issuance of a federal Letter of Map Change (LOMC).

The use and distribution of this form does not require approval from or filing with Knapp Associates. However, we do request that no changes be made to the content of the form without specific authorization of the author. We welcome an opportunity to serve both the professional issuing said disclosure and the consumer receiving same.

Questions concerning the disclosure, information concerning use and/or these instructions should contact:

Mr. Alton E. Knapp  C.F.M.
Knapp Associates
3031 State Route 40
Greenwich, N.Y. 12834-9622
(518) 692-2741
Email: knappa510@msn.com