2012 June Floods

Page One
There was an error on your page. Please correct any required fields and submit again. Go to the first error
SURVEY OF BUSINESSES AFFECTED: 2012 JUNE FLOODS

THIS IS NOT AN APPLICATION, it is a survey of affected businesses to establish a means of communication and begin preliminary damage assessment. Data collected on this form will be used by the Minnesota Department of Employment and Economic Development (DEED) and the State of Minnesota in efforts to assist communities and businesses in the recovery process.

NOTE: items marked with an asterisk are required

1.
5. Is business's plumbing/sanitation functional?
6. Did business location close due to flooding? (Choose ONE) *This question is required.
Street Address of temporary location
7. Is your residence uninhabitable?
8. Is your residence's plumbing/sanitation functional?
9. Residence address: