Pine Rock Park Tornado Survey

OEM

* Name:


* Address:


* How long have you lived at or owned property in Pine Rock Park?:


* Please describe the extent of damages (property and household contents) from the storm:


* Do you have insurance coverage for this type of event:


* Please describe any benefits you have received from this coverage


* Please describe any losses of irreplaceable possessions you have suffered as a result of the storm experience described above:


* Have you experienced any life-threatening situations associated with the conditions noted above (please specify)


* Email:


* Phone:


Message:


A * indicates a field is required