Form 085-0-1 Local Government Resolution � Collateral Security

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

O.M.B. No 1660-0083
Expires June 30, 2009

LOCAL GOVERNMENT RESOLUTION - COLLATERAL SECURITY
RESOLUTION
OF

BE IT RESOLVED BY
(Governing Body)

(Public Entity)

THAT we pledge the following listed collateral security to the Federal Emergency Management Agency (FEMA) on the
Promissory Note for a Community Disaster Loan for $
pursuant to Section 417 of the
executed on
, 20
Robert T. Stafford Disaster Relief and Emergency Assistance Act, Public Law 93-288, as amended, and FEMA Regulation,
44 CFR 206, Subpart K. We further understand that failure to repay any outstanding principal and related interest on those
portions of the loan which do not qualify for loan cancellation as determined by FEMA or any successor agency will result in
forfeiture of as much as the listed collateral security as is necessary to collect such outstanding principal and interest. (List the
collateral security below. Use additional sheets if needed.)

Passed and approved this

day of

, 20

.

(Name and Title)

(Name and Title)

(Name and Title)

CERTIFICATION
, duly appointed and

I,

of
(Title)

, do hereby certify that the above is a true and correct copy of a
of

resolution passed and approved by the

(Public Entity)

(Governing Body)

on the

day of

, 20

DATED:
(Official Position)

(Signature)

[SEAL]

FEMA Form 90-100, SEP 90

REPLACES ALL PREVIOUS EDITIONS.

.

RECORDED
,

I,

, a responsible and
(Title)

(Name)

, do hereby attest that the

authorized official of
(Public Entity)

Collateral Security Resolution which accompanies this form has been duly recorded at
(Indicate where Recorded)

The Collateral Security Resolution was recorded on the

day of

, 20

.

DATED:
(Official Position)

(Signature)

[SEAL]

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