Notice of Voluntary Interest Form
City of Columbia Flood Recovery Property Acquisition Interest Sign-up
Sheet and Voluntary Notice
Please complete the following to the best of your ability if you are interested in exploring
potential options for reducing your flood losses deemed as structural damages.
Signing this form does not commit you or the City of Columbia to any action.
Property Address:
Property Owner(s) Mailing Address (if different):
Owner(s) Name(s):
Contact Phone Number:
Tax Map Number (TMS#):
FEMA # (if assigned):
Primary Residence at the time of the flood?
Is this a Rental Property?
Is this a Commercial Property?
□ Slab
Foundation type:
□ Yes
□ Yes
□ Yes
□ Basement
□ No
□ No
□ No
□ Crawl Space
Insurance Inquiry – If applicable please check all that apply:
□ Yes, I have Property Owner’s Insurance. □ No, I do not have Property Owner’s Insurance.
If Yes, Name of Insurance Company:
Policy Number:
□ Yes, I have Commercial Insurance.
□ No, I do not have Commercial Insurance.
If Yes, Name of Company:
Policy Number:
Please turn over to complete both sides of the form.
City of Columbia Flood Recovery Property Acquisition Voluntary Interest Form - Page 2
□ Yes, I have Flood Insurance.
□ No, I do not have Flood Insurance.
If Yes, Name of Company:
Policy Number:
□ Yes □ No
Have you had any Flood Claims prior to the October 4, 2015 flood? □ Yes □ No
Did you have Flood Insurance at the time of the flood?
If yes, how many Flood Claims have you had?
Claim Date(s)
Claim Date(s)
The City of Columbia is required by Federal Emergency Management Administration (FEMA) to
inform you that your participation in this project for open-space acquisition is voluntary. Neither
the State nor the Local Government will use its eminent domain authority to acquire the property
for open-space purposes if you choose not to participate, or if negotiations fail.
Property Owner(s):
Signature
Date
Signature
Date
Property Owner(s):
□ Please check this box if you are ONLY interested in participating in the Property
Owner Rehabilitation/Elevation Project (non-acquisition).
□ Please check this box if you are NOT interested in participating in the Property
Owner Voluntary Acquisition Project or the Property Owner Rehabilitation/Elevation
Project (non-acquisition):
Please return this form to the City of Columbia in the enclosed envelope
or submit electronically to COCFloodRecovery@columbiasc.net. This
form is also available on the City’s Website at www.columbiasc.net.
PLEASE NOTE: This is strictly for informational purposes only. Further review(s) will be necessary
before any determination is made.