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� � <br />D. Check the t�•pe of Roof System on Your Property and Indicate the Area of 711et11 Roof Deck (in Square <br />Feet) under Eech Type of Roof System containing Beazer PFRI : <br />Single Ply Membrane <br />$ uilk•Up('Tar and Gravel) <br />Shingles <br />. Metal <br />Loadmaster Deck System <br />Othcr <br />Describc� <br />��t <br />squ�E� fi�es <br />quare feet <br />quare feet <br />square feet <br />square feet <br />TOTAL : 3� � a quar e feet <br />�Yc�u must also include attachments described in ��� <br />Paragraph D oJrhe attacl�ed instructions <br />E. <br />F. <br />G. <br />H. <br />Roof Completion Date with $ eazer PFRI <br />** SeeExhibit** <br />Are you aware of any roof leaks? <br />Are you aware of any manifestations of <br />roof corrosion problems? <br />REPRESENTATIONS OF CLAIMA.IYT(S) <br />Veri�cation of Claim. <br />� You should include one ar mare of the <br />attaehments described in Faragraph � <br />of the attached instructions. <br />� Yes You should include one ar more of the <br />attachments described in Paragraph �' <br />of the attached instructions, if tbev are <br />� No available. <br />� Xes You shonld include one or more of the <br />attachments described In Paragraph G <br />� No of the attached instructions, if thev are <br />available. <br />Claimant(s) represent and �� that the�iniormation, enclosures and supporting documentation submitted herewith are <br />true, correct and accurate. Claimant(s) further agree to cooperatewith � Claims Office and B eaze: with respect to <br />venfication of this Claim, including any roof inspection by the Third Party Inspectar. <br />: ti�ri �� u� �I ha thr b i my 1cF�o�x; •-4g}. information and belief, the information on this claim form is true and conect. <br />.�_�1 a _ 3-6-03 <br />SignatureofProp�riy0wner SignatureofProperryCo-Owner Date <br />