E-Gov Services City of Silverton

Disater Damage Reporting Form

WARNING! Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.

Purpose. This form is used to provide information to the Hamilton County Emergency Management Association to aid it in applying for federal disaster relief. If you experienced damage to a structure on your property as a result of the wind storm of Sunday, September 14, 2008, you may qualify for recovery assistance. Please complete the form below if you wish to participate in this program.

* Information is required.

Contact Information

* First Name:
* Last Name:
Email:
Fax:	() –
* Address:
* City:
* State:
* ZIP:

* Daytime Phone Number?

* Evening Phone Number?

Cellular Phone Number?

* Please briefly describe the damage to your property and its extent.

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.