Creekside 234 Metro Safe Room Rebate Program (MSRRP)
Floodplain Verification Form
Date: 6-4-13
Applicant Information:
Name: Joey Wells
Address: 234 Creekside Lane
City: Coppell State:TX Zip: 75019
Email Address: joeylwells @hotmail.com Phone Number: 972-342-9367
Local Floodplain Representative (LFR):
Name: I U-frrE.L 6IAQ2A- p Title: c,Lv�c,
Email Address: 015 447A e_C-cPt.41, Phone Number: cr L 3' t ,73 19
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 Signatur-.
9
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.