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STATE OF MINNESOTA <br /> Division of Emergency Management <br /> • Hazard Mitigation Grant Program (HMGP) <br /> FACT SHEET FOR ACQUISITION/RELOCATION PROJECTS <br /> Community Name: <br /> Structure Address: <br /> 1. Attach a map showing the location of the structure to be acquired/relocated (preferably using FEMA's flood <br /> boundary and floodway map or equivalent map) and, if possible, a photograph. <br /> 2. Use of structure: Residential Commercial Industrial Non-Profit Public Agric. <br /> Other <br /> 3. Type of structure: <br /> (A) 1-story without basement <br /> (B) 2-story without basement <br /> (C) Split level without basement <br /> (D) 1 or 2 story with basement <br /> • -- (E) Split level with basement <br /> (F) Mobile Home <br /> (G) Other <br /> Please use the back of this page or a separate sheet to answer the following questions: <br /> 4. Provide flood history (last 30 years) for the structure, utilizing the following format: <br /> FLOOD HISTORY (Last 30 years) <br /> Year Damaged Dollar Damage First Floor Damaged First Floor Depth of <br /> (Yes or No) Flooding <br /> 5. Flood Insurance Coverage (discuss with owner/renter): Structure Insured? Yes No <br /> Natural Flood Insurance Program Policy # <br /> Structure Contents <br /> Current Coverage Amount <br /> Insurance Payments 1993 <br /> 1992 <br /> • 1991 <br /> 1990 <br /> 1989 <br />