Orange County - Resident Damage Survey Form
INITIAL DAMAGE ASSESSMENT - GREENWOOD LAKE / WARWICK AREA
Orange County Emergency Service officials are utilizing the following survey to assess damage and determine potential eligibility for available programs. Information collected is for internal use only and does not constitute an insurance claim. Should assistance become available, residents will be contacted by phone or email provided.
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Email *
First Name *
Last Name
Street Address *
City / Town / Village 
Phone Number:
(Cell / Home /Work)
 *
Date of Damage *
Do you own or rent?
Clear selection
Property Type
Clear selection
If you rent / lease please list the owner name and contact number
Water Type
Clear selection
Damage Type / Area
 *
Required
Do you need help cleaning up? If so, what type of assistance is needed?
Description of Damage (please be specific)
"3 fallen trees - 10 inch diameter - 25 ft long along both sides of the driveway. Blocking access"
*
Extenuating Issues:
Additional comments:
Submit
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