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2. 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.
4. What date did the damage take place?
   What date did the damage take place?
5. Where is the damage located?
7. Damage to:

   1. Public (Government) Property
   2. Individual Property
   3. Business Property
8. Estimated Damage Amount
   -- Select One --$100$500$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500$5,000$5,5000$6,000$6,500$7,000$7,500$8,000$8,500$9,000$9,500$10,000
10. For damage more than $10,000, enter estimate.
12. Describe the Damage
14. If reporting damage to public property or public cooperative owned property, please fill out your name, phone number and an email address if available.
16. First Name
17. Last Name
19. Phone
20. Email Addresses
22. Repeat Email Addresses
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field