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AFFIDAVIT REGARDING <br /> FLOOD DAMAGE <br /> • <br /> STATE OF MINNESOTA ) <br /> ) ss . <br /> COUNTY OF ) <br /> being first duly sworn upon <br /> (Fill in your name here] <br /> oath, states and alleges as follows : <br /> 1 . On July 1, 1997, I real <br /> (here fill in "owned" or "leased" whichever is true] <br /> estate in St . Anthony Village, Minnesota (the "City") at the following <br /> address : <br /> 2 . As a result of the severe rainstorm that occurred in the <br /> City on July 1, 1997, water flooded the real estate that I owned or <br /> leased described above, as follows (here state in detail how the <br /> flooding occurred, including how the water entered the property (e.g. , <br /> street or alley flooding, sanitary sewer back-up, seepage through <br /> basement walls, etc. ) , what part of the property was flooded (e.g. , <br /> yard, garage, basement of home, first level of home, etc . ) ; and ap- <br /> proximate depth of water that accumulated on each part of the prop- <br /> erty] : <br /> 3 . The flooding described in Paragraph 2 above directly caused <br /> damaged to the real estate and/or personal property that I owned on <br /> July 1, 1997, as listed upon Attachments "A" and "B" attached to this <br /> Affidavit. <br /> 4 . The values of the real and personal property listed upon At- <br /> tachments. "A" and "B", together with the other information set forth <br /> on such Attachments, are true and correct to the best of my knowledge <br /> and belief. <br /> 5 . As a direct result of the damage to my property described <br /> in Paragraph 3 above, I also paid the additional expenses and costs <br /> listed upon Attachment . "C" that I would not have paid if the property <br /> damage had not occurred. The monetary amounts and other information <br /> shown on Attachment "C" are true and correct to the best of my knowl- <br /> edge and belief. <br />