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* 1. Please complete the following

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* 2. What community/subdivision do you live in? (examples: Heron Bay/Creekside, Heron Bay/Banyan Isles, PGCC/Bella Flor)

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* 3. When was your purchase date?

Purchase Date

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* 4. Provide name and ages of those residing in the home

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* 5. Do you believe your family has suffered any adverse health reactions from the Chinese drywall?

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* 6. Have you contacted your Insurance Company?

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* 7. Did your Insurance Company provide a response?

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* 8. If yes, what was your Insurance Company's response?

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* 9. Have you contacted your Builder?

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* 10. Did your Builder provide a response?

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* 11. If yes, what was your Builder's response?

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* 12. Have you contacted your Lender?

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* 13. Did your Lender provide a response?

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* 14. Are you considering or planning to relocate?

Please visit www.cityofparkland.org for additional information regarding Chinese drywall.The City of Parkland has created a “Chinese Drywall Task Force” for the limited purpose of obtaining information and compiling data for use by the City of Parkland and other governmental agencies. The “Chinese Drywall Task Force” is not authorized, to give advice or make recommendations to individual homeowners on how to proceed with regard to “Chinese Drywall” or any related issues or to regulate in any manner the building industry. You should consult with appropriate professionals or other governmental agencies to answer any questions you may have.

The City of Parkland is governed by the Public Records Act as set forth in Chapter 119, Florida Statutes. Information is subject to the Public Records Act and are public records subject to disclosure. All information sent and received are retained as public records. If you do not want your information released in response to a public records request, do not respond to this questionnaire.

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