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Damage Report Form

This form is to be used by individuals, businesses and local government jurisdictions to report damage due to storms, floods, and other natural hazards, and in some cases, man-made disasters. This information is used to tally the approximate dollar value of destruction and to see if the County reaches its threshold of damage to be eligible for Federal disaster assistance.

This is just a quick estimate. If the threshold is reached then a more formal accounting will be done.

What date did the damage take place? (ex: 06/07/2011)

Where is the damage located?

Damage to: Public (Gov't) Property
Individual Property
Business Property

Estimated Damage Amount: $

For damage more than $10,000, enter estimate: $

Describe the Damage:
If reporting damage to public property or public cooperative owned property, please fill out your name, phone number and an email address if available.
First Name:
Last Name:
Email Address:
Repeat Email Address: