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Spalding County Long Term Recovery
REGISTRATION FOR ASSISTANCE
January 12, 2023 Tornado
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Contact Information
(Required.)
Name (First, MI, Last)
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Street Address
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City
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State
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AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP Code
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Email Address
Phone Number
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Insurance Information
(If you do not have insurance, type NA in the Company field)
(Required.)
Company
Address (Street, City, Zip)
Policy Number
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Amount of Funds Received from Insurance Company
(Enter numbers and/or numbers and a decimal only. For example, $34,595.95 would be entered as 34595.95; If you do not have insurance or did not receive any funds from insurance, type 0 for the amount.)
(Required.)
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FEMA Information
(If you have not filed for assistance with FEMA, type NA in the FEMA Number field)
(Required.)
FEMA Number
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Amount of Funds Received from FEMA
(Enter numbers and/or numbers and a decimal only. For example, $34,595.95 would be entered as 34595.95; If you did not receive any funds from FEMA, type 0 for the amount.)
(Required.)
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Level of Destruction of Property
(Required.)