Hurricane Harvey Damage Questionnaire
This form is designed to help you give your input as to any unrepaired damage to your house or business.

The District does plan to review all evidence presented and make adjustments for any remaining damage as of January 1, 2018. These adjustments will be reflected on the โ€œNotice of Appraised Valueโ€ that will be mailed to you by April, 2018. The district will be unable to calculate your adjusted value before the notices are mailed.

๐๐ž๐ซ ๐“๐ž๐ฑ๐š๐ฌ ๐๐ซ๐จ๐ฉ๐ž๐ซ๐ญ๐ฒ ๐“๐š๐ฑ ๐‹๐š๐ฐ, ๐จ๐ง๐ฅ๐ฒ ๐๐š๐ฆ๐š๐ ๐ž ๐ซ๐ž๐ฆ๐š๐ข๐ง๐ข๐ง๐  ๐š๐Ÿ๐ญ๐ž๐ซ ๐‰๐š๐ง๐ฎ๐š๐ซ๐ฒ ๐Ÿ, ๐Ÿ๐ŸŽ๐Ÿ๐Ÿ– ๐ฆ๐š๐ฒ ๐›๐ž ๐œ๐จ๐ง๐ฌ๐ข๐๐ž๐ซ๐ž๐.

Account Number: *
Name: *
Property Address: *
Depth of water at the time of the flood: *
Approximately how many inches &/or feet did your home or business receive. If zero, please indicate so below.
Briefly describe the damage remaining to the home or business as of ๐‰๐š๐ง๐ฎ๐š๐ซ๐ฒ ๐Ÿ, ๐Ÿ๐ŸŽ๐Ÿ๐Ÿ–: *
Estimated cost to repair the home or business: *
Type of documents used to estimate cost for repairs: *
๐๐ฅ๐ž๐š๐ฌ๐ž ๐š๐ญ๐ญ๐š๐œ๐ก ๐š๐ง๐ฒ ๐ž๐ฏ๐ข๐๐ž๐ง๐œ๐ž ๐ญ๐ก๐š๐ญ ๐ฌ๐ฎ๐ฉ๐ฉ๐จ๐ซ๐ญ๐ฌ ๐ฒ๐จ๐ฎ๐ซ ๐๐š๐ฆ๐š๐ ๐ž ๐ž๐ฌ๐ญ๐ข๐ฆ๐š๐ญ๐ž๐ฌ ๐ฌ๐ฎ๐œ๐ก ๐š๐ฌ ๐๐š๐ญ๐ž๐ ๐ฉ๐ก๐จ๐ญ๐จ๐ฌ, ๐ข๐ง๐ฌ๐ฎ๐ซ๐š๐ง๐œ๐ž ๐ž๐ฌ๐ญ๐ข๐ฆ๐š๐ญ๐ž๐ฌ ๐จ๐ซ ๐œ๐จ๐ง๐ญ๐ซ๐š๐œ๐ญ๐จ๐ซ ๐›๐ข๐๐ฌ.
Email Address: *
Daytime Phone: *
Cell: *
I hereby certify that the information I have submitted is true and correct to the best of my knowledge and ability. *
By typing your name below, you are signing this questionnaire electronically. You agree your electronic signature is the legal equivalent of your manual signature on this questionnaire.
Today's Date: *
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