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LOMA-2542 5th Street-103013-1552 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1.660-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY 7Ntionul iloo; ELEVATION CERTIFICATE,page 2 IMPORTANT:in these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P0.Route and Box No. Policy Number; 2542 5th Street City State ZIP Code Company'NAIC Number: Encinitas CA 92024 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments SECTION C2 EQUIPTMENT SERVICING BUILDING IS A HOT WATER HEATER.THIS EQUIPTMENT IS ABOVE THE BFE. ALL ELECTRICAL SERVICING THE BUILDING IS LOCATED AT THE NW CORNER OF BUILDING MOUNTED HIGH ON THE WALL WITH ELEVATION ABOVE 49.25,THIS EQUIPTMENT IS ABOVE THE BFE. Signature Date SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,and C. For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1.Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawispace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the LAG. E2.For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is [:]feet ❑meters ❑above or ❑below the HAG. E3.Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4.Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG. E5.Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?❑Yes ❑No ❑Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. SECTION G-COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G1O.In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information.(indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3. ❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4. Permit Number G5.Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: El feet ❑meters Datum Local Official's Name AAA-51 H MA'1r,rZ Title SyNIoyz (Z\\/IL- Community Name E t-4 C1t-1 I S 4 Telephone 7 6 .33— 2-77 Signature Date + Q 0 Comments V 1 ❑Check here if attachments. I FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 2542 5th Street City Encinitas State CA ZIP Code 92024 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View' and "Left Side View." When applicable, photographs must show the foundation with 'representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. 1 3 Y 0 4. I d T a FRONT •at. i w'k I REAR 1 FEMA Form 086-0-33(7/12) Replaces all previous editions. � r � f' L � d 1 x 3 Ax r °REAR 2 p;D i .k RIGHT SIDE 1 Instructions—Page 2 y i n-- RIGHT SIDE 2 y > . u .k P J LEFT SIDE 1 Instructions—Page 3 © ©d ) . 2 . .. . . . . . - , . }« . . . 41riff � LEFT SIDE 2 Instructions—Page 4 SURVEY OF 2542 5TH ST (ENCINrTAS) ELEVATIONS CERT � PACE 1_ OF 3 JOB NO: 201X2.00— XHl Bl T A , PA GE 1 OF 3 NIFER _.. } .27 u ., 123" fit P fATo.WE AT �� Zyy v p�' , c � E"A AM CAfi W FWI% F_09? 4Qt . I I "EX�f 113f T B" PA GE 2 OF 2 CO AT LIVNG AREA 49,3 I t°' . 20' WNC 41.9 142, CO AT LIVING AREA 49,3 TOP CONC WALL 40.5 { 1t?# CtNC WALL 40.5 TOE CONC WALL 40.3 I C'E CONC WALL 40.3 G 40.1 CONC 42.1 TOP CONC WALL 40.5 CONC 40.3 F -TOE CONC WALL. 39'0 G 47.5 FF 40.3 TOP CQK WALL 405 TOE CONC WALL .3`8.8 TOP CONC WALL 40.4 GARAGE FF 40.0 TOE CONC WALL 39.1 TOP-CONC WALL,40.2 TOE CONC WALL 39.3 TOP SLOCK WALL 39.,4 T0�e ��l� WALL ,�7;1 OVERHANG OF BUILDING **_j `.1 CONC 40.7 A T TOE OF STEPS �m i CONC AT *j'YER BLDG 40.0 , AT GARAGE LEVEL • r fi TOP BLOCK WALL :39.1 1`(7E� Lf�CK WALL 37: V TOP BLOCK L 39.3 �i TOE BLOCK WALL 37.5 4 ` TOP CONC. WALL 38.9 �•+TOE CONC WALL 38.4 t� R "EXHIBI T C" PAGE 1 OF 3 PHOTO ORIENTATION REFERENCE REAR 2 REAR -1 LEFT � �► RIGHT SIDE 2 SIDE 1 RIGHT F C• SIDE 2 k .�r P r� I* 2W DEFT SIDE 1 FR ON T •ass---. ._. _ K/N y Pj pp Lr TF?Lt �4 X — I =o MAIIIII T,. x . —t f` r w r. O ID CL o ao�a� ° 0 ° w � 0 m m z5 o m_"o. — D m�� n0 4� Noim z N m D n o 0 m Z mad?„07, M .v o ° n 3 m C= . co°�.om3m _ m Q © D m II Z ' O vo�iom 7 A N m p o O 0) O^m (D 'e -0 O-0 ID S CL m0 omo A G p s'` 348 m 7y f11 Oo `� O 0m•°^a .moo Ntn 4)CA �'� m -< A m Naamm Nv 0;u ��g moo X a rn v m ° ET m ° 3 40 � 0 O O o0 Recbrding Requested by, 1/ 18653 DOC # 2003-0628832 RECORDING REQUESTED BY: MAY 29 , 2003 1 :54 PM COMMONWEALTH LAND TITLE COMPANY OFFICIAL RECORDS When Recorded Mail to: SAN DIEGO COUNTY RECORDER'S OFFICE I First Republic Bank GREGORY J. SMITH, COUNTY RECORDER 101 Pine Street FEES: 66.00 San Francisco, CA 94111 60-D65250-3 LOAN REVIEW DEPT. LOA N 1/ I (IIII111101114 till11111111 nII 411 LOA (Spaco Above This Line For Recording Data, 2003 0628832 DEED OF TRUST NOTE:This document contains a provision for Adjustable interest Rate and secures a revolving line of credit. TIIIS DEED OF TRUST("Security Instrument")is made on May 16, 2003 The trustoris Charles B. Dederich and Caroline A. Dederich, Trustees, or their successors in trust, under the Dederich Living Trust dated September 8, 1997. ("Borrower")The trustee is Fidelity National Title Insurance Company The beneficiary is First Republic Bank which is organized and existing under the laws of Nevada and whose address is 101 Pine Street, San Francisco, CA 94111 ("Lender"). This Security Instrument secures (a) all-of the obligations of Borrower under-that-certain-agreement entitled _ EQUITY SECURED LINE OF CREDIT AGREEMENT AND FEDERAL TRUTH-IN-LENDING DISCLOSURE between Borrower and Lender (the Note) as the Note may be modified, extended, renewed or replaced from time to time. The Note provides,among other things, for the establishment of a revolving line of credit in the maximum amount of $ 130,000.00 , an adjustable interest rate tied to an index and other charges, (b)the payment of all other sutras, with interest, advanced under paragraph 7 to protect the security of this Security Instrument,and(c)the performance of Borrower's covenants and agreements under this Security Instrument and the Note. For this purpose,Borrower irrevocably grants and conveys to Trustee,in trust, with power of sale, the following described property, located in SAN DIEGO County, California: See Legal description(s) attached hereto and by this reference made a part hereof. This Security Instrument is subordinate to that certain Security Instrument of even date executed by the same, Trustor in favor of First Republic Bank as beneficiary securing a note in the amount of $500,000.00 recording concurrently herewith. which has the address of 2542 5th Street Encinitas California____9202_4 ("Property Address"); (Street) ^ (City) (ZIP) Initial here:J�� �l`"•- l I of 9 F,LTDPI ---Rev.0-3/`13100 THIS DEED OF TRUST IS SECOND AND SUBORDINATE TO A DEED OF TRUST RECORDED CONCURRENTLY HEREWLTIdk I 16654 TOGETHER WITH all the improvements now or hereafter erected on the property, and all easements, appurtenances, and fixtures now or hereafter a part of the property. All replacements and additions shall also be covered by this Security Instrument. All of the foregoing is referred to in this Security Instrument as the "Property." BORROWER COVENANTS that Borrower is lawfully seized of the estate hereby conveyed and has the right:to grant and convey the Property and that the Property is unencumbered, except for encumbrances of record. Borrower warrants and will defend generally the title to the Property against all claims and demands,subject to any encumbrances of record. THIS SECURITY INSTRUMENT combines uniform covenants for national use and non-uniform covenants with limited variations by jurisdiction to constitute a uniform security instrument covering real property. UNIFORM COVENANTS. Borrower and Lender covenant and agree as follows: 1. Payment of Principal and Interest;Prepayment and Late Charges. Borrower shall promptly pay when due the principal of and interest on the debt evidenced by the Note and any prepayment and late charges due under the Note. 2. Funds for Taxes and Insurance. Subject to applicable law or to a written waiver by Lender, Borrower shall pay to Lender on the day monthly payments are due under the Note,until the Note is paid in full,a sum("Funds") for: (a) yearly taxes and assessments which may attain priority over this Security Instrument as a lien on the Property; (b) yearly leasehold payments or ground rents on the Property, if any; (c) yearly hazard or property insurance premiums;(d)yearly flood insurance premiums,if any;(e)yearly mortgage insurance premiums,if any; and(f)any suns payable by Borrower to Lender, in accordance with the provisions of paragraph 8, in lieu of the payment of mortgage insurance premiums. These items are called "Escrow (terns." Lender may, at any time, collect and hold Funds in an amount not to exceed the maximum amount a lender for a federally related mortgage loan may require for Borrower's escrow account under the federal Real Estate Settlement Procedures Act of 1974 as amended from time to time,12 U.S.C. §2601 et seq.("RESPA"),unless another law that applies to the Funds sets a lesser amount. If so,Lender may,at any time,collect and hold Funds in an amount not to exceed the lesser amount. Lender may estimate the amount of Funds due on the basis of current data and reasonable estimates of expenditures of future Escrow Items or otherwise in accordance with applicable law. The Funds shall be held in an institution whose deposits are insured by a federal agency,instrumentality,or entity (including Lender, if Lender is such an institution)or in any Federal Home Loan Bank. Lender shall apply the Funds to pay the Escrow Items. Lender may not charge Borrower for holding and applying the Funds,annually analyzing the escrow account,or verifying the Escrow Items,unless Lender pays Borrower interest on the Funds and applicable law permits Lender to make such a charge. However, Lender may require Borrower to pay a one-time charge for an independent real estate tax reporting service used by Lender in connection with this loan, unless applicable law provides otherwise. Unless an agreement is made or applicable law requires interest to be paid, Lender shall not be required to pay Borrower any interest or earnings on the Funds.Borrower and Lender may agree in writing,however, that interest shall be paid on the Funds. Lender shall give to Borrower, without charge,an annual accounting of the Funds,showing credits and debits to the Funds and the purpose for which each debit to the Funds was made. The Funds are pledged as additional security for all sums secured by this Security Instrument. If the Funds held by Lender exceed the amounts permitted to be held by applicable.law,Lender shall account to Borrower for the excess Funds in accordance with the requirements of applicable law. If the amount of the Funds held by Lender at any time is not sufficient to pay the Escrow Items when due,Lender may so notify Borrower in writing, and, in such case Borrower shall pay to Lender the amount necessary to make up the deficiency. Borrower shall make up the deficiency in no more than twelve monthly payments,at Lender's sole discretion. Initial here:/ J p 2 of 9 F;LTDP2 Rev 03/13/00 18655 Upon payment in full of all sutras secured by this Security Instrument,Lender shall promptly refund to Borrower any Funds held by Lender. If, under paragraph 21, Lender shall acquire or sell the Property, Lender, prior to the acquisition or sale of the Property,shall apply any Funds held by Lender at the time of acquisition or sale as a credit against the sums secured by this Security Instrument. 3. Application of Payments. Unless applicable law provides otherwise, all payments received by Lender under paragraphs 1 and 2 shall be applied: first, to any prepayment charges due under the Note; second, to amounts payable under paragraph 2;third,to interest due;fourth,to principal due;and last,to any late charges due under the Note. 4. Charges; Liens. Borrower shall pay all taxes, assessments, charges, fines and impositions attributable to the Property which may attain priority over this Security Instrument,and leasehold payments or ground rents, if any. Borrower shall pay these obligations in the manner provided in paragraph 2,or if not paid in that manner,Borrower shall pay them on time directly to the person owed payment. Borrower shall promptly furnish to Lender all notices of amounts to be paid under this paragraph. If Borrower makes these payments directly,Borrower shall promptly furnish to Lender receipts evidencing the payments. Borrower shall promptly discharge any lien which has priority over this Security Instrument unless Borrower: (a) agrees in writing to the payment of the obligation secured by the lien in a manner acceptable to Lender;(b)contests 1 in good faith the lien by, or defends against enforcement of the lien in, legal proceedings which in the Lender's opinion operate to prevent the enforcement of the lien; or (c) secures from the holder of the lien an agreement satisfactory to Lender subordinating the lien to this Security Instrument. If Lender determines that any part of the Property is subject to a lien which may attain priority over this Security Instrument, Lender may give Borrower a notice identifying the lien. Borrower shall satisfy the lien or take one or more of the actions set forth above within 10 days of the giving of notice. 5.Hazard or Property Insurance. Borrower shall keep the improvements now existing or hereafter erected on the Property insured against loss by fire,hazards included within the term"extended coverage"and any other hazards, including floods or flooding, for which Lender requires insurance. This insurance shall be maintained in the amounts and for the periods that Lender requires. The insurance carrier providing the insurance shall be chosen by Borrower subject to Lender's approval which shall not be unreasonably withheld. If Borrower fails to maintain coverage described above, Lender may, at Lender's option, obtain coverage to protect Lender's rights in the Property in accordance with paragraph 7. All insurance policies and renewals shall be acceptable to Lender and shalt include a standard mortgage clause. Lender shall have the right to hold the policies and renewals. If Lender requires, Borrower shall promptly give to Lender all receipts of paid premiums and renewal notices. In the event of loss,Borrower shall give prompt notice to the insurance carrier and Lender. Lender may make proof of loss if not made promptly by Borrower. Unless Lender and Borrower otherwise agree in writing,insurance proceeds shall be applied to restoration or repair of the Property damaged, if the restoration or repair is economically feasible and Lender's security is not lessened. If the restoration or repair is not economically feasible or Lender's security would be lessened, the insurance proceeds shall be applied to the sums secured by this Security Instrument,whether or not then due,with any excess paid to Borrower. If Borrower abandons the Property,or does not answer within 30 days a notice from Lender that the insurance carrier has offered to settle a claim,then Lender may collect the insurance proceeds. Lender may use the proceeds to repair or restore the Property or to pay sutras secured by this Security Instrument, whether or not then due. The 30-day period will begin when the notice is given. Initial heryC�. _/� 3 of 9 ELTDP3 Rev.031130) i IF I 18656 . Unless lender and Borrower otherwise agree in writing,any application of proceeds to principal shall not extend or postpone the due date of the monthly payments referred to in paragraphs I and 2 or change the amount of the payments. If under paragraph 21 the Property is acquired by Lender, Borrower's right to any insurance policies and proceeds resulting from damage to the Property prior to the acquisition shall pass to Lender to the extent of the sums secured by this Security Instrument immediately prior to the acquisition. 6.0ccupancy, Preservation, Maintenance and Protection of the Property; Borrower's Loan Application; Leaseholds. Borrower shall occupy, establish, and use the Property as Borrower's principal residence or other residence within sixty days after the execution of this Security Instrument and shall continue to occupy the Property as Borrower's principal residence or other residence for at least one year after the date of occupancy. Borrower shall not destroy, damage or impair the Property, allow the Property to deteriorate, or commit waste on the Property. Borrower shall be in default if any forfeiture action or proceeding,whether civil or criminal,is begun that in Lender's good faith judgment could result in forfeiture of the Property or otherwise materially impair the lien created by this Security Instrument or Lender's security interest. Borrower may cure such a default and reinstate,as provided in paragraph 18, by causing the action or proceeding to be dismissed with a ruling that,in Lender's good faith determination,precludes forfeiture of the Borrower's interest in the Property or other material impaimtent of the lien created by this Security Instrument or Lender's security interest. Borrower shall also be in default if Borrower, during the loan application process, gave materially false or inaccurate information or statements to Lender (or failed to provide Lender with any material information) in connection with the loan evidenced by the Note, including,but not limited to, representations concerning Borrower's occupancy of the i Property as a principal residence or other residence. If this Security Instrument is on a leasehold,Borrower shall comply with all the provisions of the lease. 11'Borrower acquires fee title to the Property,the leasehold and the fee title shall not merge unless Lender agrees to the merger in writing. I 7. Protection of Lender's Rights in the Property. If Borrower fails to perform the covenants and agreements contained in this Security Instrument,or there is a legal proceeding that may significantly affect Lender's rights in the Property(such as a proceeding in bankruptcy,probate, for condemnation or forfeiture or to enforce laws or regulations), then Lender may do and pay for whatever is necessary to protect the value of the Property and Lender's rights in the Property. Lender's actions may include paying any sums secured by a lien which has priority over this Security Instrument, appearing in court, paying reasonable attorneys' fees and entering on the Property to make repairs. Although Lender may take action under this paragraph 7, Lender does not have to do SO. Any amounts disbursed by Lender under this paragraph 7 shall become additional debt of Borrower secured by this Security Instrument. Unless Borrower and Lender agree to other terms of payment, these amounts shall bear interest from the date of disbursement at the Note rate and shall be payable,with interest,upon notice from Lender to Borrower requesting payment, 8.Mortgage Insurance, If Lender required mortgage insurance as a condition of making the loan secured by this Security Instrument, Borrower shall pay the premiums required to maintain the mortgage insurance in effect. If, for any reason, the mortgage insurance coverage required by Lender lapses or ceases to be in effect, Borrower shall pay the premiums required to obtain coverage substantially equivalent to the mortgage insurance previously in effect, at a cost substantially equivalent to the cost to Borrower of the mortgage insurance previously in effect, from an alternate mortgage insurer approved by Lender. If substantially equivalent mortgage insurance coverage is not available, Borrower shall pay to Lender each month a sum equal to one-twelfth of the yearly mortgage insurance premium being paid by Borrower when the insurance coverage lapsed or ceased to be in effect. Lender will accept,use and retain these payments as a loss reserve in lieu of mortgage insurance. Loss reserve payments may no longer be required, at the option of Lender, if mortgage insurance coverage (in the amount and for the period that Lender requires)provided by an insurer approved by Lender again becomes available and is obtained. Borrower shall pay the premiums required to maintain mortgage insurance in effect,or to provide a loss reserve, until the requirement for mortgage insurance ends in accordance with any written agreement between 710-7 nd Lender or applicable law. / Initial her 4 of 9 HLTDP4 3/13/00 18657 9. Inspection. Lender or its agent may make reasonable entries upon and inspections of the Property. Lender shall give Borrower notice at the time of or prior to an inspection specifying reasonable cause for the inspection. 10.Condemnation. The proceeds of any award or claim for damages,direct or consequential,in connection with any condemnation or other taking of any part of the Property, or for conveyance in lieu of condemnation, are hereby assigned and shall be paid to Lender. In the event of a total taking of the Property,the proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due,with any excess paid to Borrower. In the event of a partial taking of the Property in which the fair market value of the Property immediately before the taking is equal to or greater than the amount of the sums secured by this Security Instrument immediately before the taking, unless Borrower and Lender otherwise agree in writing,the sums secured by this Security Instrument shall be reduced by the amount of the proceeds multiplied by the following fraction:(a)the total amount of the sums secured immediately before the taking,divided by(b)the fair market value of the Property immediately before the taking. Any balance shall be paid to Borrower. In the event of a partial taking of the Property in which the fair market value of the Property immediately before the taking is less than the amount of the sums secured immediately before the taking,unless Borrower and Lender otherwise agree in writing or unless applicable law otherwise provides,the proceeds shall be applied to the sums secured by this Security Instrument whether or not the sums are then due. If the Property is abandoned by Borrower,or if,after notice by Lender to Borrower that the condemnor offers to make an award or settle a claim for damages, Borrower fails to respond to Lender within 30 days after the date the notice is given,Lender is authorized to collect and apply the proceeds, at its option,either to restoration or repair of the Property or to the sums secured by this Security Instrument,whether or not then due. Unless Lender and Borrower otherwise agree in writing,any application of proceeds to principal shall not extend or postpone the due date of the monthly payments referred to in paragraphs 1 and 2 or change the amount of such payments. 11. Borrower Not Released; Forbearance By Lender Not a Waiver. Extension of the time for payment or modification of amortization of the sums secured by this Security Instrument granted by Lender to any successor in interest of Borrower shall not operate to release the liability of the original Borrower or Borrower's successors in interest. Lender shall not be required to commence proceedings against any successor in interest or refuse to extend time for payment or otherwise modify amortization of the sums secured by this Security Instrument by reason of any demand made by the original Borrower or Borrower's successors in interest. Any forbearance by Lender in exercising any right or remedy shall not be a waiver of or preclude the exercise of any right or remedy. 12. Successors and Assigns Bound;Joint and Several Liability;Cosigners. The covenants and agreements of this Security Instrument shall bind and benefit the successors and assigns of Lender and Borrower, subject to the provisions of paragraph 17. Borrower's covenants and agreements shall be joint and several. Any Borrower who cosigns this Security Instrument but does not execute the Note: (a) is cosigning this Security Instrument only to mortgage,grant and convey that Borrower's interest in the Property under the terms of this Security Instrument; (b)is not personally obligated to pay the sums secured by this Security Instrument;and(c)agrees that Lender and any other Borrower may agree to extend,modify, forbear or make any accommodations with regard to the terms of this Security Instrument or the Note without that Borrower's consent. 13.Loan Charges. If the loan secured by this Security Instrument is subject to a law which sets maximum loan charges, and that law is finally interpreted so that the interest or other loan charges collected or to be collected in connection with the loan exceed the permitted limits,then:(a)any such loan charge shall be reduced by the amount necessary to reduce the charge to the permitted limit;and(b) any sums already collected from Borrower which exceeded permitted limits will be refunded to Borrower. Lender may choose to make this refund by reducing the principal owed under the Note or by making a direct payment to Borrower. if a refund reduces principa reduction will be treated as a partial prepayment without any prepayment charge under the Note `c inkial heie: f 5 of 9 ELTDP5 Rev.03/13/00 18658 14.Notices. Any notice to Borrower provided for in this Security Instrument shall be given by delivering it or by mailing it by first class mail unless applicable law requires use of another method. The notice shall be directed to the Property Address or any other address Borrower designates by notice to Lender. Any notice to Lender shall be given by first class mail to Lender's address stated herein or any other address Lender designates by notice to Borrower. Any notice provided for in this Security Instrument shall be deemed to have been given to Borrower or Lender when given as provided in this paragraph. 15.Governing Law;Severability. This Security Instrument shall be governed by federal law and the law of the jurisdiction in which the Property is located. In the event that any provision or clause of this Security Instrument or the Note conflicts with applicable law,such conflict shall not affect other provisions of this Security Instrument or the Note which can be given effect without the conflicting provision. To this end the provisions of this Security Instrument and the Note are declared to be severable. i 16.Borrower's Copy. Borrower shall be given one conformed copy of the Note and of this Security Instrument. 17. Transfer of the Property or a Beneficial Interest in Borrower. If all or any part of the Property or any interest in it is sold or transferred(or if a beneficial interest in Borrower is sold or transferred and Borrower is not a natural person)without Lender's prior written consent,Lender may,at its option,require immediate payment in full of all sums secured by this Security Instrument. However, this option shall not be exercised by Lender if exercise is prohibited by federal law as of the date of this Security Instrument. If Lender exercises this option, Lender shall give Borrower notice of acceleration. The notice shall provide a period of not less than 30 days from the date the notice is delivered or mailed within which Borrower must pay all sums secured by this Security Instrument, If Borrower fails to pay these sums prior to the expiration of this period, Lender may invoke any remedies permitted by this Security Instrument without further notice or demand on Borrower. 18.Borrower's Right to Reinstate. If Borrower meets certain conditions,Borrower shall have the right to have enforcement of this Security Instrument discontinued at any time prior to the earlier of: (a)5 days(or such other period as applicable law may specify for reinstatement)before sale of the Property pursuant to any power of sale contained in this Security Instrument; or (b) entry of a judgment enforcing this Security Instrument. Those conditions are that Borrower:(a)pays Lender all sums which then would be due under this Security Instrument and the Note as if no acceleration had occurred;(b)cures any default of any other covenants or agreements;(c)pays all expenses incurred in enforcing this Security Instrument, including,but not limited to, reasonable attorneys' fees; and (d) takes such action as Lender may reasonably require to assure that the lien of this Security Instrument, Lender's rights in the Property and Borrower's obligation to pay the sums secured by this Security Instrument shall continue unchanged. Upon reinstatement by Borrower,this Security Instrument and the obligations secured hereby shall remain fully effective as if no acceleration had occurred. However, this right to reinstate shall not apply in the case of acceleration under paragraph 17. 19.Sale of Note;Change of Loan Servicer. The Note or a partial interest in the Note(together with this Security Instrument)may be sold one or more times without prior notice to Borrower. A sale may result in a change in the entity (known as the "Loan Servicer") that collects monthly payments due under the Note and this Security Instrument. There also may be one or more changes of the Loan Servicer unrelated to a sale of the Note. If there is a change of the Loan Servicer,Borrower will be given written notice of the change in accordance with paragraph Ih above and applicable law. The notice will state the name and address of the new Loan Servicer and the address to which payments should be made. The notice will also contain any other information required by applicable law. a Liitial t�-Lf here --- ( L�J 6 of 9 ELTD116 Rev.03/13/00 18659 20.Hazardous Substances. Borrower shall not cause or permit the presence,use,disposal,storage,or release of any Hazardous Substances on or in the Property. Borrower shall not do, nor allow anyone else to do, anything affecting the Property that is in violation of any Environmental Law. The preceding two sentences shall not apply to the presence, use, or storage on the Property of small quantities of Hazardous Substances that are generally recognized to be appropriate to normal residential uses and to maintenance of the Property Borrower shall promptly give Lender written notice of any investigation,claim,demand,lawsuit or other action by any governmental or regulatory agency or private party involving the Property and any Hazardous Substance or Environmental Law of which Borrower has actual knowledge. If Borrower leams, or is notified by any governmental or regulatory authority,that any removal or other remediation of any Hazardous Substance affecting the Property is necessary, Borrower shall promptly take all necessary remedial actions in accordance with Environmental Law. As used in this paragraph 20, "Hazardous Substances" are those substances defined as toxic or hazardous substances by Environmental Law and the following substances: gasoline, kerosene, other flammable or toxic petroleum products, toxic pesticides and herbicides, volatile solvents, materials containing asbestos or formaldehyde,and radioactive materials. As used in this paragraph 20, "Environmental Law"means federal laws and laws of the jurisdiction where the Property is located that relate to health,safety or environmental protection. NON-UNIFORM COVENANTS. Borrower and Lender further covenant and agree as follows: 21. Acceleration; Remedies, Lender shall give notice to Borrower prior to acceleration following Borrower's breach of any covenant or agreement in this Security Instrument(but not prior to acceleration under paragraph 17 unless applicable law provides otherwise). The notice shall specify:(a)the default;(b)the action required to cure the default;(c)a date,not less than 30 days from the date the notice is given to Borrower, by which the default must be cured; and (d)that failure to cure the default on or before the date specified in the notice may result in acceleration of the sums secured by this Security Instrument and sale of the Property. The notice shall further inform Borrower of the right to reinstate after acceleration and the right to bring a court action to assert the non-existence of a default or any other defense of Borrower to acceleration and sale. If the default is not cured on or before the date specified in the notice,Lender at its option may require immediate payment in full of all sums secured by this Security Instrument without further demand and may invoke the power of sale and any other remedies permitted by applicable law. Lender shall be entitled to collect all expenses incurred in pursuing the remedies provided in this paragraph 21,including,but not limited to,reasonable attorneys' fees and costs of title evidence. If Lender invokes the power of sale, Lender shall execute or cause Trustee to execute a written notice of the occurrence of an event of default and of Lender's election to cause the Property to be sold. Trustee shall cause this notice to be recorded in each county in which any part of the Property is located. Lender or Trustee shall mail j copies of the notice as prescribed by applicable law to Borrower and to the other persons prescribed by applicable . law. Trustee shall give public notice of sale to the persons and in the matmer prescribed by applicable law. After the time required by applicable law,Trustee,without demand on Borrower,shall sell the Properly at public auction to the highest bidder at the time and place and under the terms designated in the notice of sale in one or more parcels and in any order Trustee determines. Trustee may postpone sale of all or any parcel of the Property by public announcement at the time and place of any previously scheduled sale. Lender or its designee may purchase the Property at any sale. i Trustee shall deliver to the purchaser Trustee's deed conveying the Property without any covenant or warranty, expressed or implied. The recitals in the Trustee's deed shall be prima facie evidence of the truth of the statements made therein. Trustee shall apply the proceeds of the sale in the following order: (a)to all expenses of the sale, including, but not limited to, reasonable Trustee's and attorneys' fees; (b) to all sums secured by this Security Instrument;and(c)any excess to the person or persons legally entitled to it. Initial hevle/6 7 of 9 ELTDP7 I 1 18660 22. Reconveyance. Upon payment of all sums secured by this Security Instrument,Lender shall request Trustee to reconvey the Property and shall surrender this Security Instrument and all notes evidencing debt secured by this Security Instrument to Trustee. Trustee shall reconvey the Property without warranty to the person or persons legally entitled to it. Borrower will have to pay a recording fee and a reconveyance fee for release of this Security Instrument. 23. Substitute Trustee. Lender,at its option,may from time to time appoint a successor trustee to any Trustee appointed hereunder by an instrument executed and acknowledged by Lender and recorded in the office of the Recorder of the county in which the Property is located. The instrument shall contain the name or the original Lender, Trustee and Borrower, the book and page where this Security Instrument is recorded and the name and address of the successor trustee. Without conveyance of the Property,the successor trustee shall succeed to all the title,powers and duties conferred upon the Trustee herein and by applicable law. This procedure for substitution of trustee shall govern to the exclusion of all other provisions for substitution. 24.Request for Notices. Burrower requests that copies of the notices of default and sale be sent to Borrower's address which is the Property Address. i 25.Statement of Obligation Fee. Lender may collect a fee not to exceed the maximum amount permitted by law for furnishing the statement of obligation as provided by Section 2943 of the Civil Code of California. 26. Riders to this Security Instrument. If one or more riders are executed by Borrower and recorded together with this Security Instrument,the covenants and agreements of each such rider shall be incorporated into and shall amend and supplement the covenants and agreements of this Security Instrument as if the rider(s)were a part of this Security Instrument. Check applicable box(es) Equity Line Rider ❑ Condominium Rider 1-4 Family Rider iGraduated Payment Rider ❑ Planned Unit Development Rider Biweekly Payment Rider Balloon Rider Rate Improvement Rider Second Home Rider XQ Other(s)[specify] Legal Description, INTER VIVOS TRUST RIDER BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any rider(s)executed by Borrower and recorded with it. Charles . Deder AZT Trustor Carotins A. Dederich, Trustee -Trustor Trustor -Tlustor 8(t 9 ELTDP8 Rer.031130) X02 o oa nap �A O / ✓C o/ �'p u A � O ST – °y •Ni f ZJ '� W x a n 70 tiT o z ° ea o O� o� �O� zA � y n .� O ` -j d" z O rmME' H OD o` ` �D mss v DO y\ V �S Q�:i 1 �✓3�,. Igo D Ow 7ao+Y r �a� R. a ro DO * o ti� pD m �� o�m� ,� AD Nwv v� w jo /�; maDno a v2'o"InmaD m°san o�.ADO/yu Ga va CLSQ �, N �m�w"o;n 4 AO�\ 'gym waA Am m l 'o h. _ �CCL�^ t �°o�iJti Ain AN � Do, y /'.:: � SI: l D A i1NO t.j I- //F iDV�P ,�\s3n "w r> �T F.`g / / //ww lWn .�" W �v oN ,��o�• ST RQ o/ ` 1 ` VI j=i3.9 N b °V�>> rYiSY S s♦•> �.o° p aa.sa ` 4V N OJaAtiX mNu — dvC) �D aFO w e A A F 7' O 0 nO�\ fn D 0 D_ /ss s9—, n AOb y Lxa ae (u t . N W DO y s• Oo vvA 3o. ; B?^STe P is/�` _ ,'33�9 _ / I° ADO ti E 5B �,�>• rn rn N%aF�o�p?.E N 61 N� a` `r.29 'r G/r� a ti ACDi tiH f•,L.SfNti�N UO2� bC AD JD ,(�� Ln OO Q D' OW N n NH uv /L'�. 4( �a, Md ate' .i A0° Bg, E a (P B �y\�k WADNS D. DO/ J N n � 1 ` (u N/ Si5yq sa �p�N Otiv D c wf\� .y 111 m of y OD - b Sr. CL Lam, Ad L wO v A4 N' to ;u KKK (n'U U U J 2 rn D AWj IV +y� n ti O 0)OD ' ' A :E Don p �� ��o OD O= I AN; N Wapn N� 0.� o FR pocno Q�Z �N J f'— N 11 Q to ZZ S w NN w W � o rn OD (yJ• O .p b(� T Z- 0 —p n _ p JW � SN —Q °D • � V C: f�O� 0) 0 w I 1 V 6 so xWi o� a_ 4x-' N U !nl iv �- �• y,r.� 'off'+.ranee• 8B � �N�°:�p ?, A 44 M ' i •Y a '<-r•• r r- � � z "O �u t n amt UA lip i r co �� � �•�QQ}9''mmsm��,� � ma r31 '' m� a�^�A�,L 0' � Mm �� 5 � � �, V WO 114/ 0994 i DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 PROPERTY INFORMATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on 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,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this 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. In order to process your request,all information on this form must be completed in its entirety,unless stated as optional. Incomplete submissions will result in processing delays. Please check the item below that describes your request: ❑J LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill(natural grade)would not be inundated by the base flood. ❑ CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill(natural grade)would not be inundated by the base flood if built as proposed. ❑ LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by fill ❑ CLOMR-F 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(including the subject property)placed that raises the ground to or above the Base Flood Elevation(BFE). The common construction practice of removing unsuitable existing material(topsoil)and backfilling with select structural material is not considered the placement of fill if the practice 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 considered natural grade. Has fill been placed on your property to raise ground that was previously below the BFE? ❑ Yes ❑■ No If yes,when was fill placed? / month/year Will fill be placed on your property to raise ground that is below the BFE? ❑ Yes* ❑■ No If yes,when will fill be placed? / month/year *If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructions). 1. Street Address of the Property(if request is for multiple structures or units,please attach additional sheet referencing each address and enter street names below): 2542 5TH Street Encinitas CA 92024 2. Legal description of Property(Lot,Block,Subdivision or abbreviated description from the Deed): APN # 259-221-53 3. Are you requesting that a flood zone determination be completed for(check one): Structures on the property? What are the dates of construction? 08/30/1977 (MM/YYYY) ❑ 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 surveyor or registered professional engineer,are required.For the preferred format of metes and bounds descriptions,please refer to the MT-1 Form 1 Instructions.) ❑ The entire legally recorded property? 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: ) DHS-FEMA Form 086-0-26, FEB 11 Property Information Form MT-1 Form 1 Page 1 of 2 In addition to this form(MT-1 Form 1),please complete the checklist below. ALL requests must include one copy of the following: ❑� Copy of the effective FIRM panel on which the structure and/or property location has been accurately plotted(property inadvertently located in the NFIP regulatory floodway will require Section B of MT-1 Form 3) ❑� Copy of the Subdivision Plat Map for the property(with recordation data and stamp of the Recorder's Office) OR Copy of the Property Deed(with recordation data and stamp of the Recorder's Office),accompanied by a tax assessor's map or other certified map showing the surveyed location of the property relative to local streets and watercourses. The map should include at least one street intersection that is shown on the FIRM panel. 0 Form 2—Elevation Form. If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot elevation must be provided on 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 For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may include a copy of an Incidental Take Permit,an Incidental Take Statement,a"not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S.Fish and Wildlife Service(USFWS),or an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or listed species or designated critical habitat.Please refer to the MT-1 instructions for additional information. Please do not submit original documents. Please retain a copy of all submitted documents for your records. DHS-FEMA encourages the submission of all required data in a digital format(e.g.scanned documents and images on Compact Disc[CD]). Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result in processing delays.For additional information regarding this form,including where to obtain the supporting documents listed above,please refer to the MT-1 Form Instructions located at http://www.fema.gov/plan/prevent/fhni/dl mt-l.shtm. Processing Fee(see instructions for appropriate mailing address;or visit http://www.fema.gov/fhm/frm fees.shtm 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 lot(s)/structure(s)LOMAs are fee 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 or 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 applicable 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 Title 18 of the United States Code,Section 1001. Applicant's Name(required): Charles N WIIIesS Company(if applicable): Gold Coast Surveying Inc. Mailing Address(required): Daytime Telephone No.(required): (760)758_7732 P.O. box 1876 Vista, CA 92085 E-Mail Address(optional):❑N By checking here you may receive Fax No.(optional): 760-758-7733 correspondence electronically at the email address provided): gcsl@att.net Date(required) 10/29/2013 Signature of Applicant(required) DHS-FEMA Form 086-0-26,FEB 11 Property Information Form MT-1 Form 1 Page 2 of 2 3 DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO,1660-0015 ELEVATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on 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,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS-FEMA National Flood Insurance Program(NFIP)Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),including an attached deck or garage.For requests to remove an entire parcel of land from the SFHA,provide the lowest lot elevation; or,if the request involves an area described by metes and bounds,provide the lowest elevation within the metes and bounds description.All measurements are to be rounded to nearest tenth of a foot. In order to process your request,all information on this form must be completed in its entirety. Incomplete submissions will result in processing delays. + ,1 1. NFIP Community Number: 060726 Property Name or Address:2542 5TH Street Encinitas CA 92024 2. Are the elevations listed below based on X existing or ❑proposed conditions? (Check one) 3. For the existing or proposed structures listed below,what are the types of construction? (check all that apply) ❑crawl space❑■ slab on grade ❑basement/enclosure ❑other(explain) 4. Has DHS-FEMA identified this area as subject to land subsidence or uplift?(see instructions) ❑Yes ❑■ No If yes,what is the date of the current re-leveling? / (month/year) 5. What is the elevation datum?❑NGVD 29 ❑O NAVD 88 ❑Other(explain) If any of the elevations fisted below were computed using a datum different than the datum used for the effective Flood Insurance Rate Map (FIRM)(e.g.,NGVD 29 or NAVD 88),what was the conversion factor? Local Elevation+/-ft.=FIRM Datum 6. Please provide the Latitude and Longitude of the most upstream edge of the structure(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ❑WGS84 ❑■ NAD83 ❑NAD27 Lat.330 2'21.10"N Long. 117-1.4'1.30"W Please provide the Latitude and Longitude of the most upstream edge of the property(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ❑WGS84 ❑■ NAD83 ❑NAD27 Lat.33° 219.90"NLong. 117°141.80"W Lowest Block Lowest Lot Adjacent Base Flood Address Lot Number BFE Source Number Elevation* Grade To Elevation Structure 2542 5TH Street Encinitas CA 92024 40.00 39.75 FIRM This certification is to be signed and sealed by a licensed land surveyor,registered professional engineer,or architect authorized by law to certify elevation information. 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 Title 18 of the United States Code,Section 1001. Certifier's Name: License No.: Expiration Date:06/30/2014 Charles N.Willess 3654 Company Name: Telephone No.: Gold Coast Surveying Inc. 1-760-758-7732 Email: Fax No. gcsi @att net 1-760-758-7733 U Signature: ^rJ� �y✓ 10/29Date/2013 'O 'CHARL,ES N &L WIL.L.E'SS :! �_ SIG 3554 *For requests involving a portion of property,include the lowest ground elevation within 30^ the metes and bounds description. f+�Qal (Optlopa'f)���' T r+rrrr+ Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a determination Q f, �l�� will be issued for the structure only. DHS-FEMA Form 086-0-26A, FEB 11 Elevation Form MT-1 Form 2 Page 1 of 2 i Continued from Page 1. Lowest Adjacent Lowest Lot Base Flood Address Lot Number Block Number Grade To BFE Source Elevation* Structure Elevation This certification is to be signed and sealed by a licensed land surveyor,registered professional engineer,or architect authorized by law to certify elevation information. 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 Title 18 of the United States Code,Section 1001. Certifier's Name: License No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: *For requests involving a portion of property,include the lowest ground elevation within Seal(optional) the metes and bounds description. Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be issued for the structure only. DHS-FEMA Form 086-0-26A,FEB 11 Elevation Form MT-1 Form 2 Page 2 of 2 !l l DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 COMMUNITY ACKNOWLEDGMENT FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on 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,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must be completed for requests involving the existing or proposed placement of fill(complete Section A)OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway(complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays.Please refer to the MT-1 instructions for additional information about this form. Community Number: Property Name or Address: A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements,including the requirement that no fill be placed in the regulatory floodway,and that all necessary Federal,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. For Conditional LOMR-F requests,the applicant has or will document Endangered Species Act(ESA)compliance to FEMA prior to issuance of the Conditional LOMR-F determination.For LOMR-F requests,i acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process.Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm an endangered species,a permit is required from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F requests,we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: Community Official's Name and Title: (Please Print or Type) M As t A M A H GR Telephone No.: 27 7/od-(o'3 3- 7 Community Name: Community Official's Signature (required) Date: t 0/301 2 013 B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible for floodplain,management,I hereby acknowledge that we have received and reviewed this request for a LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature(required): Date: DHS -FEMA Form 086-0-26B,FEB 11 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1 FEDERAL EMERGENCY MANAGEMENT AGENCY PAYMENT INFORMATION FORM Community Name: Project Identifier: THIS FORM MUST BE MAILED,ALONG WITH THE APPROPRIATE FEE,TO THE ADDRESS BELOW OR FAXED TO THE FAX NUMBER BELOW. Please make check or money order payable to the National Flood Insurance Program. Type of Request: LOMC Clearinghouse ❑ MT-1 application 847 South Pickett Street ❑ MT-2 application} Alexandria,VA 22304-4605 Attn.: LOMC Manager FEMA Project Library ❑ EDR application 847 South Pickett Street Alexandria,VA 22304-4605 FAX(703)212-4090 Request No.(if known): Check No.: Amount: ❑ INITIAL FEE* ❑ FINAL FEE ❑ FEE BALANCE** ❑ MASTER CARD ❑ VISA ❑ CHECK ❑ MONEY ORDER *Note: Check only for EDR and/or Alluvial Fan requests(as appropriate). **Note:Check only if submitting a corrected fee for an ongoing request. COMPLETE THIS SECTION ONLY IF PAYING BY CREDIT CARD CARD NUMBER EXP. DATE m m 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Month Year Date Signature NAME(AS IT APPEARS ON CARD): (please print or type) ADDRESS: (for your credit card receipt-please ' print or type) DAYTIME PHONE: FEMA Form 81-107 Payment Information Form a