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Ouachita Parish Office of Homeland Security and Emergency by n1884

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									                                                    Ouachita Parish Office of Homeland Security

                                                           and Emergency Preparedness


                                                               Storm Damage Report



DATE:                  Month ______________                Day ___________            Year __________________


NAME:
                       Last                                         First                           Middle

ADDRESS:
                       Street

CITY/STATE/ZIP:
                       City                                         State                           Zip Code

PHONE NUMBER:

CELL NUMBER:           _____________________________


STRUCTURE DAMAGE (Check all that apply):
        ___Home                 ___Garage                  ___Storage Building

        ___Work Shop            ___Pool                    ___Other

Explain Other:
TYPE OF STRUCTURE         (Check all that apply):

___Slab (Above ground)          ___Elevated 1st Floor ___Brick              ____Wood     ___Other

SIZE OF STRUCTURE:
        Bedrooms                 Baths                   Approximate Square Footage:


DO YOU HAVE HOME OWNER’S INSURANCE?                        ___YES            ___ NO


DO YOU HAVE FLOOD INSURANCE?                               ___YES            ___ NO



NOTE: Reporting this to the Ouachita Parish Office of Homeland Security and Emergency Preparedness does not
guarantee that you will be entitled to reimbursement.

Email: bbeckham@ohsep.net                    Fax: 318-322-7356                 Address: 1000 New Natchitoches Road
                                                                                         West Monroe, LA 71291

								
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