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Report Damage to Property
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You are completing an online report for Damage to Property. This report is intended for situations where damage has occurred but is not a result of vandalism and you have no suspects. Examples would include: a grocery cart strikes you car or a rock hits your windshield. Please write a detailed narrative including who, what, when, where and how.
Please give a detailed description of incident
When did this incident occur? Please include start and end times and dates.
Problem Location
Street Number and Name:
*
*
Address Line 2:
City:
*
State:
*
Zip Code:
Photograph:
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Your Information
Name:
*
Date of Birth
*
Driver's License Number
Drivers License State of Issue
Race
*
Gender
*
Street Number and Name:
*
Address Line 2:
City:
*
State:
*
Zip Code:
*
Phone Number:
*
Fax Number:
Email Address:
*
Preferred Contact Method:
*
Do NOT contact me
Email
* indicates required fields.
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