Flood Insurance Return Form - Pinellas County Property Appraiser
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FLOOD INSURANCE RETURN
PLEASE COMPLETE AND RETURN TO THE PINELLAS COUNTY PROPERTY APPRAISER WITHIN 10 DAYS
Dear Property Owner:
In 2012, Congress passed a bill to change the National Flood Insurance Program. This bill will result in higher
flood insurance premiums for new property owners in high-risk flood zones. We are contacting you to determine
whether you were aware of the changes when you purchased your property, and the price you paid for flood
insurance, if you purchased it. This information will help us assess the impact of flood insurance on property
values. Thank you.
Please provide the following information for the person completing this form:
Name:
Daytime Phone:_____________________________
_____________________________________________
Email: _________________________________________ Date: _______________________
1. Were you aware of flood insurance price increases when you purchased this property?
Yes
No
2. Was this a cash purchase?
Yes
No
3. Did you purchase flood insurance when you purchased this property?
Yes
No
*If No, STOP here and return the form.
*If Yes, please continue.
4. Who is your insurance provider?:
National Flood Insurance Program (NFIP)
Private Insurance Company (list name):
_______________________________________________
5. What was the PRIOR owner’s flood insurance annual rate (if known)? $____________________
6. What is your CURRENT flood insurance annual rate? $____________________
7. Do you have an elevation certificate on the property?
Yes*
No
*If Yes, please provide a copy.
8. Please attach any additional information or documents related to your property’s elevation level,
flood zone, or flood insurance that you believe may be relevant to the property value.
FOR OFFICE USE ONLY:
Pinellas County Property Appraiser
Return to:
PO Box 1957 - Clearwater, FL 33757
Email:
Fax: 727-464-3448 Website:
ac/rev. 3/14
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