Submit by Email
Print Form
THE LORAIN COUNTY OFFICE OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY 322 GATEWAY BOULEVARD NORTH, ELYRIA, OHIO 44035
MAJOR DAMAGE ASSESSMENT FORM Name:
_____________________________________________________________________________________________
Address:
_____________________________________________________________________________________________
Phone:
_______________________ (Home) _______________________ (cell) _______________________ (other)
CHECK ONE OR MORE OF THE FOLLOW:
Damage:
____
18 inches of water or more on the first floor living space or water that covers Electrical outlets on the first floor
____
Home with a basement where the water level has compromised the structural integrity of the home (basement walls)
____
Uninhabitable. Will take thirty (30) or more days to repair. Do you have flood insurance?
____ yes ____ no
RETURN THIS PAGE TO THE LORAIN COUNTY OFFICE OF EMERGENECT MANAGEMANT AND HOMELAND SECURITY AS SOON AS POSSIBLE. YOU CAN EMAIL THE FORM TO: TKELLEY@LORAINCOUNTY.US FAX: 440-322-1272. THE FORM CAN BE FILLED OUT ON YOUR COMPUTER BY PUSHING NUMLOCK AND INSERT.
THE LORAIN COUNTY BOARD OF COMMISSIONERS LORI KOKOSKI TED KALO TOM WILLIAMS