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2. 
3. Maury County Emergency Management Damage Assessment Form will help us identify any damage in your area. Should a problem require urgent attention, please call us immediately. For a police/ fire/ medical emergency, dial 911. Otherwise call (931) 698-6800.
5. Please complete the required information below. We will contact you as quickly as possible.
7. Thank you for your assistance!
9. Contact Information
11. First Name:*
12. Last Name:*
14. Business Name*
16. Business Address:*
18. City*
19. State*
20. Zip*
22. Phone Number:*
23. Email Address*
25. Please answer the question
27. Type of Damage*

    1. Flood
    2. Wind
    3. Earthquake
    4. Collapse
28. Habitable*

    1. Yes
    2. No
    3. Not Sure
29. Owner/Occupants*

    1. Own
    2. Rent
    3. Lease
31. Estimated Property Loss*
33. Brief Description (or other problem not listed)
35. Please upload any pictures of damage
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field