* 1. What was the date of proposed closing that DID NOT close due to lack of property insurance coverage or date policy was not renewed by Citizens Property Insurance Corp.?

Estimate date if not known.

* 2. What was the replacement cost or sales price?

* 3. What was the property address? Include numberic, street, city and zip code.

* 4. What was the type of structure?

* 5. Was the property hurricane hardened/mitigated?

* 6. Was there a mortgage associated with the property?

* 7. What was the reason(s) given for decline in coverage?

* 8. Do you have additional comments you would like to share?

* 9. What's the REALTOR® or Homeowner's Contact Info?

* 10. Insurance Agent/Company Info