info@co.carbon.mt.us
17 W. 11th St, PO Box 887, Red Lodge, MT, 59068, US
Completion of this document will help determine if there is any assistance available for individual homeowners. Please complete this document as thoroughly as possible. If additional information is needed you may be contacted for clarification. Be sure to supplement this form with photographs that document your damages.
Date
Full Name
Full Address
Phone Numbers
Level of home affected? (check all that apply)
Amount of water in home?
Is your septic system operational?
Was your furnace destroyed by the flooding?
Was your hot water heater destroyed by the flooding?
Do you have a mold issue?
Is this your primary residence?
Do you rent?
Is the home inaccessible due to flood waters?
Is or was your family displaced?
Do you have homeowners insurance that will cover these damages?
Do you have flood insurance that will cover these damages?
Is you home habitable?
