Property Address: [Property Address]
City, State, ZIP Code: [City, State, ZIP Code]
Parcel Number, if applicable: [Parcel Number]
Disclosure Date: [Date]
Disclosing Party: [Full Name / Company Name]
Role: [Seller / Owner / Landlord / Manager / Other]
Address: [Address]
1. Purpose of Disclosure
This Flood Zone Disclosure Form is provided to disclose the known flood-zone status, flood-risk information, flood history, and related insurance information for the property identified above.
This disclosure is based on the current actual knowledge of the Disclosing Party as of the date of this document.
2. Flood Zone Status
To the best of the Disclosing Party’s knowledge, the property is:
☐ located in a FEMA-designated Special Flood Hazard Area
☐ not located in a FEMA-designated Special Flood Hazard Area
☐ located in or near another mapped flood-risk area
☐ unknown
If known, flood zone designation:
[Flood Zone Designation]
If known, FEMA map panel or reference number:
[Map Panel / Reference]
Additional flood-zone details, if any:
[Insert details]
To the best of the Disclosing Party’s knowledge:
☐ flood insurance is currently maintained on the property
☐ flood insurance is currently required by a lender
☐ flood insurance has previously been required
☐ flood insurance is not currently maintained
☐ unknown
Insurance carrier, if known: [Carrier Name]
Policy type or reference, if known: [Policy Details]
Additional insurance details, if any:
4. Prior Flooding or Water Intrusion
To the best of the Disclosing Party’s knowledge, the property has experienced:
☐ no known flooding
☐ interior flooding
☐ exterior flooding affecting improvements
☐ drainage overflow
☐ storm surge impact
☐ sewer or stormwater backup
☐ other: [Describe]
Dates or approximate periods of known events:
Description of known flood or water events:
5. Prior Damage and Repairs
Known flood-related damage, water damage, remediation, or repairs:
[Insert details or write “None known”]
If repairs were made, describe them here:
If professional remediation, drying, reconstruction, or elevation work was completed, describe it here:
6. Claims, Assistance, or Notices
To the best of the Disclosing Party’s knowledge, the property has had:
☐ no known flood insurance claims
☐ prior flood insurance claim(s)
☐ prior disaster assistance
☐ governmental flood-related notice
☐ mitigation or elevation grant assistance
☐ other: [Describe]
Details:
The following flood-mitigation or elevation information is known:
☐ elevation certificate exists
☐ flood vents installed
☐ raised utilities
☐ drainage improvements completed
☐ sump or water-control system installed
☐ other mitigation measure: [Describe]
☐ none known
If this disclosure relates to a pending transaction, the Disclosing Party understands that separate lender or closing requirements may also apply.
Related transaction, if any:
☐ sale
☐ lease
☐ refinance
☐ loan application
☐ other: [Describe]
Related contract date, if any: [Date]
Other known facts that may materially affect flood risk, insurance cost, insurability, repair history, or use of the property:
10. No Warranty Statement
This disclosure is provided for information purposes only and is based on the current actual knowledge of the Disclosing Party.
Except as otherwise stated in a separate written agreement, this form is not a warranty or guarantee of future flood conditions, insurability, flood mapping outcomes, or lender requirements.
11. Buyer or Recipient Review
The recipient is encouraged to conduct independent due diligence, including review of flood maps, insurance requirements, inspection results, public records, and lender or governmental determinations.
Receipt of this disclosure does not replace inspections, appraisals, insurance review, legal review, or formal flood determinations.
12. Signatures
Disclosing Party Signature: __________________________
Name: [Full Name]
Title, if applicable: [Title]
Date: [Date]
Recipient Acknowledgment, if desired:
Recipient Signature: __________________________
Name: [Full Name]
Date: [Date]
