Describe how damage occurred - i.e. broken window, hole in roof, lightening, etc.

Describe all property that was damaged, type of damage and where damaged property is. Be specific - i.e. address of each building damaged, roof damage to 1234 Maple Drive, 3456 Maple Drive; windows broken on unit numbers 34,36,37; water intrusion to cabana causing damage to interior south wall, tree fell on recreation building, etc.

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For Insurance Department Use Only

Date Received______by________Acknowledgement sent to B.O.D.____________
Name of insurance company_______________________________
Date called in to insurance company____________
Name of insurance company personnel taking claim_____________
Claim number if available with submission____________________
Claim submitted via phone______ fax_______ email________
Data Entry Date_______________
Cc to Property Manager________________________________