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  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.