McDowell County Damage Assessment Reporting Form
McDowell County, NC
Name of Property Owner
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address of Affected Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Property
*
Residential
Commercial
Public Infrastucture
Bridge/Culvert
Other
Number of Stories
1
2
3
Other
Estimated Square Footage
Estimated Building Damage (excluding contents)
0-25%
25-50%
50-75%
75-<100%
100%
None
Insured? (Select all that apply)
*
Yes, Homeowner's Insurance
Yes, Flood Insurance
No Insurance on property
Other
Type of Damage
*
Flooding
Wind Damage
Structural Damage
Debris
Utility Outage
Bridge/Culvert Damage
Other
Severity of Damage
*
Minor (cosmetic/small repairs)
Major (significant structural repair)
Destroyed (Uninhabitable/non-repairable)
Unsure
Description of Damage
Please provide a brief description of damage to the property.
Upload Photos of Property Damage
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Any additional information or notes:
Representative Contact Information
Please provide your contact information if you are completing this form on behalf of a property owner, so we can follow up with any questions if needed.
Name of Representative (if completing on behalf of property owner; for follow-up purposes)
First Name
Last Name
Phone # of Representative
Latitude
Email of Representative
Longitude
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