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Exceptional Disaster Relief Loan Application
HSEM Form 1 - Edition 9/2020
EXCEPTIONAL DISASTER RELIEF LOAN APPLICATION (RSA 21-P:37-c)
When the President of the United States declares an area a federal disaster area and a municipality has applied for federal emergency assistance for the Federal Emergency Management Administration (FEMA), the governor with the approval of the executive council, may approve a loan in the amount up to the anticipated assistance from FEMA from funds not otherwise appropriated. In order to be eligible for an Exceptional Disaster Relief Loan, the pre-occurrence cost of a municipality's critical disaster relief project or projects shall equal or exceed 25% of the amount raised by local property taxes in the municipality's last annual budget.
a
APPLICANT INFORMATION
a
APPLICANT (municipality)
DATE SUBMITTED
COUNTY (Location of Damages. If located in multiple counties, please indicate)
a
APPLICANT ADDRESS
a
Street Address
CITY
COUNTY
STATE
ZIP
a
PRIMARY CONTACT
a
a
ALTERNATE CONTACT
a
Name
First
Last
Name
First
Last
BUSINESS PHONE
BUSINESS PHONE
FAX NUMBER
FAX NUMBER
CELL PHONE
CELL PHONE
EMAIL ADDRESS
*
EMAIL ADDRESS
a
LOAN REQUEST DETAILS
a
___ / ___ /______ - ___ /___ /______
LAST ANNUAL BUDGET PERIOD
$
LOCAL PROPERTY TAXES RAISED LAST PERIOD
$
LOAN AMOUNT REQUESTED
$
25% of LOCAL PROPERTY TAXES RAISED
Did you participate in the Federal/State Preliminary Damage Assessment (PDA)?
Yes
No
Did you submit a Request for Public Assistance (PDA)?
Yes
No
Total number of active Exceptional Disaster Relief Loans
1
:
Requested Term of Loan
2
:
3 years
5 years
1
A municipality shall not receive more than one Exceptional Disaster Relief Loan per declared federal disaster. A municipality shall not be obligated for more than 2 Exceptional Disaster
2
A municipality receiving an Exceptional Disaster Relief Loan shall remit the anticipated assistance from FEMA to the State Treasurer within 15 days of receipt. The interest rate assessed on advanced funding shall be no greater than the prevailing rate at which the State Treasury is able to invest its commingled cash. If the amount of FEMA assistance a municipality receives is less than the Exceptional Disaster Relief Loan, the State Treasurer, with the advice and consent of the Governor and Executive Council, shall negotiate terms of repayment for the difference. If the municipality and the State Treasurer are unable to reach an agreement, the Department of Revenue Administration shall include the amount in the amount apportioned for setting property tax rates.
By signing below, I attest that I am duly authorized by the applicant to apply for “Exceptional Disaster Relief Funds” in accordance with RSA 21-P:37-c and that all statements in connection with this application are true and correct.
Date:
Month
Day
Year
By:
Title:
