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McHenry County, IL
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Please correct the fields below:
Please correct the field(s) marked in red below:
Please provide information below. If this is an emergency, please dial 911. For help with Health and Human Services, dial 211. Information submitted below will be used to better assess disaster impacts on McHenry County.
Contact Information
*
Contact Information
Street Address (number, street name, street type) *
City *
Full Name
Email Address *
Phone Number
Dwelling Information
Type:
*
Type:
Single Family
Multi Family
Mobile Home
Business
Own/Rent:
*
Own/Rent:
Own
Rent
Unknown
Condition:
*
Condition:
Habitable without repairs
Habitable with repairs
Uninhabitable - needs extensive repairs
Total loss - Not feasible to repair
Insurance Type:
*
Insurance Type:
Home Owner's
Renter's
None
Unknown
Structural damage due to the incident?
*
Structural damage due to the incident?
Yes
No
Additional Information (check any that apply):
Additional Information (check any that apply):
A - No one living at the residence when the damage occurred
B - Dwelling was not a primary residence
C - No one home during damage assessment
1 - No power
2 - No water/sanitary
3 - Missing, displaced or damaged structural supporting members
4 - Estimated cost more than 50% value
5 - Estimated cost less than 50% value
6 - Unstable; collapse possible
7 - Damaged accessory structures
8 - Home business
9 - Uninhabitable
To receive a copy of your submission, please fill out your email address below and submit.
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