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Damage Survey

  1. (This is not an application for assistance. The purpose of this document is to gather damage information in order to assess the level of assistance.)
  2. Home Owner Type*
  3. Home Type*
  4. Rental Property Status*

    If this is your secondary residence, is the property used as a vacation rental?

  5. (such as, completely destroyed, smoke damage, inaccessible, vehicle loss, etc.)

  6. Insurance Coverage

    (such as, Homeowner’s Insurance or Rental Insurance)

  7. Was the property insured?*
  8. Does your property include Additional Living Expenses (ALE)?*
  9. Please answer the following:

  10. 1. Was the property used as a home business*
  11. 2. Are you unemployed, or have you lost your income as a result of this disaster?*
  12. 3. Have you been able to obtain copies of vital records that may have been destroyed? *

    (i.e., birth certificates, driver’s license, vehicle registrations, etc.)

  13. 5. If applicable, would you like to be contacted by non-profit agencies that may assist with Long Term Recovery Efforts?
  14. Leave This Blank:

  15. This field is not part of the form submission.