Purpose: To notify local government of damage in your area
The Citizen Request page requires JavaScript to function. Please enable JavaScript or update your browser to create a request.
For instructions on how to enable JavaScript, visit
www.enable-javascript.com
.
If you're updating your web browser, we recommend using
Google Chrome
or
Mozilla Firefox
.
Location
Emergency event:
This report is for:
-- SELECT A REPORT TYPE --
Residential
Business
Damage Report Type is required
Address:
Address is required
Zipcode:
Five digit Zipcode is required
Description
Brief description of damage:
Types of Damage (check all that apply):
Driveway/Private Bridge Destroyed
Tree on House
Flood waters entered the home but water levels were below electrical outlets
Flood waters entered the home and water levels reached above electrical outlets
Damage to chimney
Damage to mechanical components (e.g., furnace, boiler, water heater, heating, ventilation, and air conditioning (HVAC), etc.)
Damage to well or private septic system
House knocked off foundation/Structural Damage
Debris on property
Debris in home
Damage to roof
Add Images:
Upload Photos
Please enter the following information if this is your property:
Do you have homeowner's insurance?
Yes
No
Don't Know
Is this a business?
Yes
No
Don't Know
If yes, enter the business name:
Contact Information
Please provide the following information about yourself:
Your First Name:
Your Last Name:
Your Phone Number:
Your Email:
Submit Request
Reset Form
×
Reset form input?
