Damaged or Destroyed Property Reporting Form

Use the following form to report damaged or destroyed property to Cottonwood County Emergency officials. You will be contacted if additional information is needed.

Damaged Property Information

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* 1. Damaged Property Information

Mailing Address (if different from above)

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* 2. Mailing Address (if different from above)

Parcel Identification Number (PIN)

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* 3. Parcel Identification Number (PIN)

Do you own this property?

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* 4. Do you own this property?

Is this your primary residence?

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* 5. Is this your primary residence?

Is this property insured?

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* 6. Is this property insured?

Do you have flood insurance?

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* 7. Do you have flood insurance?

Date of Damage Occurrence

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* 8. Date of Damage Occurrence

Date / Time
Type of Damage Reported

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* 9. Type of Damage Reported

Briefly describe damage to the property

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* 10. Briefly describe damage to the property

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