Do you or any residents of the structure have any special needs issues?
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Yes
No
If Yes, please explain.
Do you need any assistance with the following immediate needs?
Type of Damage
If you are reporting both flood and wind damage from the same event, you must
select severe storm.
What Kind of Damage are you reporting?
-----
Severe Storm
Winter Storm
Explosion
Fire
Earthquake
Wind/Tornado
Flooding
Type of Property Damaged
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Home
Business
Other
Please Select the Specific Type
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Single Family
Apartment
Condominium
Manufactured Housing
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Garage
Auto
Outbuilding
Landscaping
Agriculture
Insurance
Did the damage occur in a designated floodplain?
-----
Yes
No
Is the property insured for this damage?
-----
Yes
No
If yes, what is the company name?
Do you have homeowners insurance?
-----
Yes
No
If yes, what is the company name?
Do you have sewer back-up insurance?
-----
Yes
No
If yes, what is the company name?
Do you have flood insurance?
-----
Yes
No
If yes, what is the company name?
Do you have content insurance coverage for this disaster?
-----
Yes
No
Do you need assistance with debris removal?
-----
Yes
No
If yes, please check
Type of debris that needs removed:
Does your roof need a temporary tarp to mitigate further damage?
-----
Yes
No
Do your windows need secured (tarpped or boarded up)?
-----
Yes
No
Do your doors need secured (boarded for security)?
-----
Yes
No