Form 60-25 FEMA's Excess Federal Real Property Program--Public Bene

U. S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

O.M.B. NO. 1660-0080
Expires February 28, 2007

EXCESS FEDERAL REAL PROPERTY

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PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 3 hours per response. The burden estimate includes the time for reviewing instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U. S. Department of Homeland Security,
Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0080). NOTE: Send
completed form to: Federal Emergency Management Agency, Facility, Policy and Oversight Branch, 500 C Street SW, Washington DC 20472.

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SECTION I APPLlCANTlREClPlENT DATA
1. APPLICANTS NAME

2. ORGANIZATION
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3. ADDRESS

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4. CITY

5. COUNTY

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8. CONGRESSIONAL DISTRICT(S)
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7. ZIP CODE

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6 . STATE
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9. NAME OF CONTACT

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10. FAX NUMBER

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11. E-MAIL ADDRESS

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II TYPE OF ACTION
1. PROPERTY IDENTIFICATION (Name, if applicable)

2. GSA NUMBER (If applicable)
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4. DATE APPLICANT ADVISED GSA OR BRAC OFFICE OF INTEREST (Please
provide copies of letters)

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3. BASE REALIGNMENT IDENTIFICATION (If applicable)
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5. TITLE OF APPLICANTS PROJECT

6. Provide a brief description of applicant's project (please provide detailed information referencing your emergency management response use of the
property):

a. Describe the emergency management response organization to benefit from the conveyance.

b.

Describe the emergency management response programlproject activities (e.g.. training).

c.

Provide a table for accomplishing renovationlconstructionand implementing the program after the property is certified or
conveyed, and deeded.

d.

Recommend language that could be included in the properly conveyance document establishing conditions for the perpetual use of
the property for the emergency management response facility.

FEMA Form 60-25, Mar 04

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SECTION II -ACQUISITION AUTHORIN
1. Identify the State and local government agency that is authorized by law to enter into contracts with the Federal Government for the conveyance of real

property. (Please provide a copy of the State enabling legislation and cite the actual paragraph or portion of the legislation that establishes that authority).

2. If the above-authorized agency is not the applicant agency, provide written delegation from the authorized agency to procure the requested property.

3. Include a proposal.

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SECTION Ill ENVIRONMENTAL ISSUES
The applicant proposes continued use of the existing facility in ways similar to its previous use. Based upon FEMA experience in the implementation of
similar measures, the environmental impact of the identified use would be none to minimal. The applicant's description of the proposed use does not
indicate any special issues that would suggest a different level of impact in this case. The applicant and any agency funding, issuing permits, or enacting
the property transfer or project implementation should consider additional information as appropriate to comply with relevant State and Federal
environmental laws and executive orders. This compliance would also apply if and when a day care center is added to the facility.
SECTION IV - CERTIFICATION

1 certify that to the best of my knowledge and belief, that the data in this application is true and correct, that the governing body of the applicant has duly
authorized the application, that the applicant proposes continued use of the facility in ways similar to its previous use, that the proposed use does, not
indicate any special environmental concerns, and that the property transfer or project implementation will comply with all relevant State and Federal
environmental laws and executive orders.

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SIGNATURE OF CERTIFYING REPRESENTATIVE

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