PRELIMINARY DAMAGE ASSESMENT / INDIVIDUAL ASSISTANCE

Page of

County Name of Community Area Date of PDA Assessor's Name/Phone Number

LOCATION TYPE OF STRUCTURE STATUS NOTES/TALLY DEPTH OF WATER HABITABILITY INS
Street Address, Apt/Condo, Complex, MH Park SF, MH, Apt, Condo, Bus Own/Rent Basement/ 1st Floor D Maj Min A Y/N
TOTALS