Form 81-87 Property Information Form

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

PROPERTY INFORMATION FORM

O.M.B. NO. 1660-0015
Expires August 31, 2007

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.63 hours per resposne. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form.
You are not required to respond to this collection of information unless a vaild OMB control number appears in the upper right corner of this
form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections
Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472,
Paperwork Reduction Project (1660-0015). Submission of the form is required to obtain or retain benefits under the National Flood Insurance
Program. Please do not send your completed survey to the above address.
This form may be completed by the property owner, property owner's agent, licensed land surveyor, or registered professional engineer to
support a request for a Letter of Map Amendment (LOMA), Conditional Letter of Map Amendment (CLOMA), Letter of Map Revision Based on
Fill (LOMR-F), or Conditional Letter of Map Revision Based on Fill (CLOMR-F) for existing or proposed, single or multiple lots/structures.
Please check the item below that describes your request.
A letter from FEMA stating that an existing structure or parcel of land that has not been elevated by fill (natural
LOMA
grade) would not be inundated by the base flood.
CLOMA

A letter from FEMA stating that a proposed structure that is not to be elevated by fill (natural grade) would not be
inundated by the base floodif built as proposed.

LOMR-F

A letter from FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be
inundated by the base flood.

CLOMR-F

A letter from FEMA stating that a parcel or land or proposed structure that will be elevated by fill would not be
inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed.

Fill is defined as material from any source placed to raise the ground to or above the Base Flood Elevation (BFE). The common construction
pratice of removing unsuitable existing material (topsoil) and backfill with select structural material is not considered the placement of fill if the
pratice does not alter the existing (natural grade) elevation, which is at or above the BFE. Fill that is placed before the date of the first National
Flood Insurance Program (NFIP) map showing the area in a Special Flood Hazard Area (SFHA) is not considered natural grade.
Has fill been placed on your property?

Will fill be placed on your property?

Yes

No

Yes

No

If yes, when was fill placed?

If yes, when will fill be placed?

Month/Year

Month/Year

1. Street Address of the Property (If request is for multiple structures, please attach additional sheet):

2. Legal description of Property (Lot, Block, Subdivision) (If a street address cannot be provided):

3. Are you requesting that the SFHA designation be removed form (check one):
The entire legally recorded property?
A portion of land within the bounds of the property (a certified metes and bounds description and map of the area to be removed, certified by a
licensed land serveyor or registered professional engineer, are required)?
Structure on the property? What are the dates of construction?
4. Is this request for a (Check one):
Single structure
Single lot
Multiple structures (How many structures are involved in your request? List the number:

Multiple lots (How many Lots are involved in your request? List the number:

FEMA Form 81-87, FEB 06

Property Information

MT-1 Form 1 Page 1 of 2

In addition to this form (MT-1 Form 1), All request must include the following:
Copy of the Plat Map for the property (with recordation data and stamp of the Recorder's Office)
Copy of the property Deed (with recordation data and stamp of the Recorder's Office) , accompined by a tax assessor's map or other certified
map showing the surveyed location of the property relative to local streets and watercourses
Copy of the effective FIRM panel and/or Flood Boundary and Floodway Map (FBFM) (if applicable) on which the property location has been
accurately plotted (porperty inadvertently located in the NFIP regulatory floodway will reqire Section B of MT-1 Form 3)
Form 2 - Elevation Form. If an Elevation Certificate has been completed for this property, it may be submitted in addition to Form 2
Please include a map scale and North arrow on all maps submitted
For LOMR-Fs and CLOMR-Fs, the following must be submitted in addition to the items listed above:
Form 3 - Community Acknowledgment Form

Processing Fee (See instructions for appropriate mailing address for fee submittal; visit www.fema.gov/mit/tsd/frm_fees.htm for the most current fee schedule)
Revised fee schedules are published periodically, but no more than once annually, as noted in the Federal Register. Please note: single/multiple los(s)/structure
(s) LOMAs are free exempt. The current review and processing fees are listed below:
Check the fee that applies to your request:
$325 (single lot/structure LOMR-F following a CLOMR-F)
$425 (single lot/structure LOMR-F)
$500 (single lot/structure CLOMA-F, CLOMR-F)
$700 (multiple lot/structure LOMR-F, following a CLOMR-F, or multiple lot/structure CLOMA)
$800 (multiple lot/structure LOMR-F, or CLOMR-F)

Please submit the Payment Information Form for remittance of apllicable fees. Please make your check or money order payable to: National Flood Insurance
Program.
All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or
imprisonment under Ttile 18 of the United States Code, Section 1001.

Applicant's Name:

Company:
Please Print or Type

Mailing Address:

Daytime Telephone No.:

FAX No.:
E-Mail Address:
(Optional)

Signature of Applicant (required)

Date

If you have any questions concerning FEMA policy, or the NFIP in general, please contact the FEMA Map Assistance Center toll free at 1-877-FEMA MAP
(1-877-336-2627) or visit the Flood Hazard Mapping website at www.fema.gov/mit/tsd.
FEMA Form 81-87, FEB 06

Property Information Form

MT-1 Form 1 Page 2 of 2