[Community letterhead]

Memo of Review For Correctness and Completion

The attached FEMA Elevation Certificate has been reviewed by this office.

The items noted below are not correct on the attached form and should read as entered on this page.

SECTION A - PROPERTY INFORMATION	For Insurance Company Use:
A1. Building Owner’s Name	Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.	Company NAIC Number
City State ZIP Code
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. Long. Horizontal Datum: NAD 1927 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? Yes No d) Engineered flood openings? Yes No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION

B1. NFIP Community Name & Community Number	B2. County Name	B3. State

B4. Map/Panel Number	B5. Suffix	B6. FIRM Index Date	B7. FIRM Panel Effective/Revised Date	B8. Flood Zone(s)	B9. Base Flood Elevation(s) (Zone AO, use base flood depth)

B10.	Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.

FIS Profile	FIRM	Community Determined	Other (Describe)

B11.	Indicate elevation datum used for BFE in Item B9:	NGVD 1929	NAVD 1988	Other (Describe)

B12.	Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?	Yes	No

Designation Date	CBRS	OPA

Local Official’s Name Title
Community Name Telephone
Signature Date
Comments