October 2015 Flood Damage Assessment Form

2. City officials are asking residents who have flood damage to contact the City to help assessment teams get an accurate count of damaged properties within the city limits.

   City officials are asking residents who have flood damage to contact the City to help assessment teams get an accurate count of damaged properties within the city limits.

4. First Name

5. Last Name

7. Address1

9. Address2

11. City

12. State

13. Zip

15. Phone Number

16. Email Address

18. Inches of water that flooded property

19. Estimated cost of damage (if known)

21. Description of flood damage

23. Please add photo of damage being reported

24. Please add photo of damage being reported

26. Please add photo of damage being reported

27. Please add photo of damage being reported

29. Please add photo of damage being reported

31. Do you need flood damage volunteer assistance?

    1. Yes

    1. No

33. If yes, please select the following type:

    1. Inside clean-up
    2. Debris removal
    3. Structure repairs

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field