This form maybe used to report damage sustained to your residential/commercial structure. Along with submitting this form, SPCAD requests that you go to hharvey@sanpatcad.org to provide your supporting documentation such as photos, contractor estimates, receipts, insurance claims and/or FEMA reports, etc.. If you prefer to print a downloadable version of this form, please click here.

This form must be signed and dated. By signing this document, you attest that the information contained on it is true and correct to the best of your knowledge and belief. If you make a false statement on this form, you could be found guilty of a Class A misdemeanor or a state jail felony under Penal Code Section 37.10

Step 1:

Owner's
or lessee's
name and
address

Owner's or lessee's first name and middle initial

Last name

Owner's or lessee's present mailing address (number and street)

City, town or post office, state, ZIP code

Phone (area code and number)

Step 2:

Describe
property

Give street address and city if different from above, or legal description if no street address

Appraisal district account number (optional)

Mobile homes: (Give make and identification number)

Step 3:

Description of
Hurricane
Harvey
Damage

Wind Damage
Flooding
Roof Damage
Sheetrock
Other
Description of Damage

Repairs

Started
Complete
No Repairs Made
Structure is habitable as of Jan 1, 2018

Step 4:

Give facts that may help resolve your case

What is your opinion of value lost due to the storm damage? (optional)

$