Damaged or Destroyed Property

First Name *

Last Name *

Damaged Property Address *

City or Township *
—Please choose an option—City of WinonaCity of GoodviewCity of LewistonCity of St. CharlesCity of AlturaCity of DakotaCity of ElbaCity of La CrescentCity of Minnesota CityCity of MinneiskaCity of Rolling StoneCity of StocktonCity of UticaDresbach TownshipElba TownshipFremont TownshipHart TownshipHillsdale TownshipHomer TownshipMount Vernon TownshipNew Hartford TownshipNorton TownshipPleasant Hill TownshipRichmond TownshipRollingstone TownshipSaratoga TownshipSt. Charles TownshipUtica TownshipWarren TownshipWhitewater TownshipWilson TownshipWiscoy Township

Mailing Address

If different from damaged property address.

Daytime Phone Number *

555-555-5555

Evening Phone Number *

555-555-5555

Email Address *

Date of Damage *

Type of Damage Being Reported *
Flood DamageStorm (wind, hail, etc) DamageOther Damage

Select ANY that apply to your property's damage. *
Foundation damageWater seepage in basementZero to five inches of water in basementSix or more inches of water in basementWater on main level of homeFurnace or water heater damagedElectrical/outlets damagedStorm damage to exteriorSewer back-upOther damage

Briefly Describe Damage to Property

Please leave this field empty.

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