Vacant/Abandoned Structure Form
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Address of Structure
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Structure
Type of Structure
Vacant
Abandoned
Under Construction
Other
Are any of the following utilities active?
Electric
Gas
Water
Structure Contact Person (If known) and Phone Number
Hazards to Personnel
Example: boarded up windows, previous fire damage, etc
Exposures to the structure
Upload any Photos of the structure (can upload multiple photos)
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of
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Should be Empty: