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Person(s) physically living at the Address listed above.
Phone number of Owner/Resident where shelter is located
Alternate phone number contact for person(s) that may be located in shelter
Use of the property
Select the type of Shelter listed above. Even if no shelter, location in house when taking shelter
Number of Occupants inside shelter
Number of Pets inside shelter
Water, Food, Medication within Shelter
Fill out field with any special medical needs, like Oxygen, High Blood Pressure, Heart Patient, etc.
Approx Year that Safe Room was installed/constructed. If cellar, date not needed
Select whether or not this is a rental or not.
* indicates a required field