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2. 
3. City of Nassau Bay

   Tropical Storm Nicholas Flood Damage Reporting Form

5. Please let us know if your home suffered flood damage due to Tropical Storm Nicholas.

   This form was created to assist the Nassau Bay Office of Emergency Management in determining what areas of our community have experienced flood damage so we can then evaluate those locations. Please DO NOT use this form to request direct assistance or disaster relief. As always, call 911 for emergency assistance.

7. First Name*
8. Last Name*
10. Phone Number*
11. Email*
13. Physical Address that Incurred Damage*
15. Date Damage Occurred *
    Date Damage Occurred
16. Subdivision
18. Address1
20. City
21. State
22. Zip
24. Did you have water in your home?*

    1. Yes
    2. No
25. If your home flooded, what caused your flooding? (check all that apply)*

    1. Storm Surge
    2. Rain
27. How high was the water in your home? (ex. 3 in, 1ft)*
28. Did your home suffer wind damage?*

    1. Yes
    2. No
30. Describe your home's damage*
32. Do you have home insurance?*
    -- Select One --YesNo
33. Do you have flood insurance?*
    -- Select One --YesNo
35. Do you own or rent your home?*
    -- Select One --OwnRent
36. If you have any photos of your damage please upload them here
38. Are there any other issues regarding your home or the City that you would like to report?
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field