Forms • Waseca County Emergency Management Damage Report for

Waseca County Emergency Management Damage Report for Townships

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Township Name*

Person Reporting Damage*

Title*

Phone Number*

E-mail Address*

Date of Damage*

Type of Damage*

Damaged Location*

Category of Eligible Work (Check all that apply)*

	Debris Removal
	Emergency Protective Measures
	Road and Bridges
	Water Control Facilities

Estimated Cost*

Photos Taken*

Yes

Percentage of work currently completed*

Township Budget

* indicates required fields.