Form FEMA Form 90-31 FEMA Form 90-31 Landowner's Authorization Ingress-Egress Agreement

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
LANDOWNER'S AUTHORIZATION
INGRESS-EGRESS AGREEMENT

1. REGISTRATION NO.

See Reverse side for
Instructions and
Paperwork Burden Notice

2. LANDOWNER'S INFORMATION

O.M.B. No. 1660-0030
Expires November 30, 2010

3. APPLICANT SITE INFORMATION

NAME

NAME

ADDRESS (House No. and Street Name)

SITE ADDRESS (House No. and Street Name)

CITY AND STATE (Include Zip Code)

CITY AND STATE (Include Zip Code)

PHONE NO. (Include Area Code)

NOTE: PROVIDE DIRECTIONS AND ATTACH MAP IF NECESSARY

4. In consideration of the President's Disaster Proclamation of

(DR #)

(date of declaration)

and the furnishing of a temporary housing unit by

the United States of America to the above applicant, a disaster victim, and other good and valuable considerations not herein expressly stated, and intending to be bound
hereby, the Landowner (which term shall, for the purposes of this agreement, include the owner of record and any parties in possession) does hereby agree with the
applicant as follows:
a. The Landowner hereby certifies that he/she is the owner of the above described property and authorizes placement of a temporary housing unit on his/her land
for use of the subject applicant for the temporary housing period established by the United States Government.
b. The Landowner agrees that no in debt ness of his/hers will become a lien on the said housing unit, and that he/she will not attempt to restrain the owner of
the unit from removing it from the subject property.
c. The Landowner agrees to allow and maintain a route on ingress and egress for placing and removing the temporary housing unit along and across the subject
property to the nearest reasonable access to a public street. This agreement includes the prohibition of structures and barriers upon the property which would
hinder or preclude the normal and usual connecting, parking, placing, hitching, or removing of the temporary housing unit.
d. The Landowner further agrees to maintain a reasonable route of ingress and egress along and across the property to and from the temporary housing unit
for the applicant.
e. The Landowner has agreed that the following alterations to the property may be made to assure adequate ingress and egress or to allow for utility
connections to existing utility service on the property. No claims will be filed by Landowner for these actions. (List removal of trees, shrubs, fences, grading
holes in driveway or foundation, etc.) Attach drawing of agreed-upon ingress and egress route.

5. This Agreement shall remain in force for 30 days following termination of occupancy of the temporary housing unit in accordance with procedures and regulations
promulgated by the Government.
6. Site preparation costs will be the responsibility of: (Check one)
Provide details if responsibility is divided:

the applicant;

7. Landowner intends to charge and applicant agrees to pay

8. SIGNATURE

landowner;

other (specify)

/month rent for use of the property. (Mark "None" if no rent is to be charged)

DATE

a. OWNER/AGENT
b. APPLICANT
c. WITNESS

FEMA Form 010-0-10, FEB 08

REPLACES ALL PREVIOUS EDITIONS. (This form was consolidated with FF90-41, May 91)

GENERAL INFORMATION
a. PURPOSE: The Landlord's Authorization is used to obtain the approval of the owner of a property for the placement and removal of a
mobile unit to be used for temporary housing. The purpose of the Ingress-Egress is to obtain the approval of the owner/agent of a property
through which a mobile unit must travel to reach a private site (generally properties adjacent to the proposed site) to ensure placement and
removal of the unit.
b. RESPONSIBILITY: The applicant is responsible for obtaining the Landowner's Authorization from the owner of the proposed site. In
an ingress-egress situation, the applicant must obtain the Ingress-Egress Agreement from as many of the property owners as necessary to
ensure adequate ingress-egress for the site. The applicant will be provided the form by FEMA.
c. DISTRIBUTION:

Original-Applicant
Copy No. 1-Mobile Home Operations
Copy No. 2-Landowner
Copy No. 3-Applicant
Copy No. 4-(Photocopy) Applicant Assistance

INSTRUCTION FOR COMPLETING FORM
Explain the procedure for placement of a mobile unit and the reasons for requiring the Landowner's
Authorization before giving the applicant this document.
1. T.H. Application Number: To be obtained from applicant Assistance.
2. Landowner Information:
can be located.

Provide complete name of legal owner of property and current address and telephone number where owner

3. Applicant Site Information: Give name and address. Provide detail instructions or map if location is not clear from address.
4e. Give detail description of alterations that will be made and attach a clear map of agreed upon ingress-egress route(s).
6. Specify who will have responsibility for site preparation including clearance, provision of utilities, connection of utilities etc. (If If
responsibility is divided, provide detailed explanation).
7. If owner does not intend to charge rent "None" should be marked in the blank provided.
8. Signature/Dates
a. Owner: Signature of individual legally empowered to enter into agreement regarding the property. May be owner or legal agent.
b. Applicant: Signature of head of household or other legally responsible member of household. Individual state laws must be
observed in determining legal responsibility. If adults not related by marriage (i.e., adult sisters/brothers, parent and adult child,
college roommates, etc.) all legally responsible adults must sign authorization.
c. Witness: The signing by the applicant and the owner/agent must be witnessed by someone unrelated to either party.

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 10 minutes per response. Burden means the time, effort, and financial
resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments
regarding the burden estimate or any aspect of the form, including suggestions for reducing the burden to: Information Collections
Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20472,
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number is displayed in the upper right corner of this form. NOTE: Please do not send your completed form to the above
address.