Dobecka 101 Metro Safe Room Rebate Program (MSRRP)
Floodplain Verification Form
E h
Date: 06/03/2013
Applicant Information:
Name: Tuu Tran
Address: 101 Dobecka Dr.
City: Coppell State:TX Zip: 75019
Email Address:paultdtran @yahoo.com Phone Number:972 393 6804
Local Floodplain Representative(LFR):
n
Name: ,A/1,U-i � C--�C}..,0(kI 4). . AA Title: L- ftl 1Ir1/ CL
Email Address: Phone Number: C— /9 `'l• Z o 1°)
DISCLAIMER:According to the maps provided by the National Flood Insurance Program(NFIP)and available to the local entity,the
property listed above does not appear to be in the Special Flood Hazard Area(SFHA)or in a designated FEMA Flood Zone A or AE.The
Local Floodplain Representative(LFR)listed above does not verify the establishment or confirm the location of SFHA floodplain areas
with respect to property limits or structures.Note that SFHA's on NFIP maps are not a guarantee that any particular location is not
subject to inundation,only that it is denoted as reasonably safe from flooding.
LFR Signature: ..41`S111111•
Applicant:
Please upload/submit the completed document as your name_FPVerification"with your application as you set-up your user profile
at:www.nctsaferoom.com.