Damaged or Destroyed Property

First Name *

Last Name *

Damaged Property Address *

City or Township *
City of JanesvilleCity of ElysianCity of New RichlandCity of WaldorfCity of WasecaAlton TownshipBlooming Grove TownshipByron TownshipFreedom TownshipIosco TownshipJanesville TownshipNew Richland TownshipOtisco TownshipSt. Mary TownshipVivian TownshipWilton TownshipWoodville 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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