Damage Report Form

2. This form is to be used by individuals, business 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 the destruction and to see if Wright 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.

   This form is to be used by individuals, business 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 the destruction and to see if Wright 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? (xx/xx/xxxx)*
   What date did the damage take place? (xx/xx/xxxx)

6. Where is the damage located?*

8. Damage to:*

   1. Public (Gov't) Property
   2. Individual Property
   3. Business Property

10. Estimated Damage Amount:*

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

14. Describe the Damage:*

16. If reporting damage to public property or public cooperative owned property, please fill out your name, phone number and an email address if available.

18. First Name

19. Last Name:

20. Phone Number:

22. Email Address:

23. Repeat Email Address:

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 Submit and Print

* indicates a required field