If your cultural institution has sustained damage due to a recent disaster, we encourage you to fill out this form. Heritage Preservation collects this information on behalf of the Heritage Emergency National Task Force and closely guards the information you share. The information you provide will allow us to assess the extent of damage on the ground and mobilize the appropriate support at the local and federal level. If you have questions about this report, please do not hesitate to contact us at info@heritagepreservation.org.

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* 1. Report Type:

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* 2. State:

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* 3. City:

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* 4. Report:

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* 5. Source of information:

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* 6. Contact for more information if different than the person submitting this report (first and last name, email and/or phone number):

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* 7. Information current as of date/time:

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* 8. First and last name of person submitting this report:

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* 9. Email address:

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