The City of Portland, Oregon

Portland Housing Bureau

Phone: 503-823-2375

fax: 503-823-2387

1900 SW 4th Avenue, Suite 7007, Portland, OR 97201

Help: How to use this form

* Required Field

Name of preparer*

Organization*

Email*

Name of homebuyer(s)*

Address of property being acquired*

e.g. 1120 SW 5TH or 5TH AND MAIN

Federal funding source*

If Other, please describe

Federal funding amount*

Full sales price of property*

FEMA Firmette*

(Maximum file size: 30MB)

If home is in floodplain, copy of flood insurance requirement

(Maximum file size: 30MB)

Google map showing distance between address and PDX airport*

(Maximum file size: 30MB)