Berkeley County Hurricane Damage Report Form

Location of Damage (Street Address or TMS#) First Name Last Name Company Name (if applicable) Mailing Address Mailing City Mailing State ARMY AMERICA ARMY EUROPE ALASKA ALABAMA ARMY PACIFIC ARKANSAS American Samoa ARIZONA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA Guam HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI Northern Mariana Islands MISSISSIPPI MONTANA NORTH CAROLINA NORTH DAKOTA NEBRASKA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEVADA NEW YORK OHIO OKLAHOMA OREGON PENNSYLVANIA Puerto Rico RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VIRGINIA US Virgin Islands VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING Mailing Zip Phone Email Owner/Occupant -- select an option -- Owner Occupant Owner/Occupant Stucture Type -- select an option -- Commercial Building Detached Home Mobile Home Duplex/Townhome Multi-Family Other Residential Damage Extent -- select an option -- Affected Destroyed Inaccessible Major Minor Description of Damage Select image to upload (must be of types GIF,PNG, or JPG, and less than 4MB in size)



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