Q. Is the mailing address same as the affected address?
A. Yes

Q. Do you have a Basement, Crawl Space or Utility Room?
A. Basement

Q. Is the Water backing up through the floor drain?
A. Yes

Q. Is the Water clear or is there raw sewage?
A. Raw Sewage

Q. Is your basement still flooded?
A. No

Q. Are you Disabled or a Senior Citizen that Needs Assistance?
A. No

Q. Do you have large items that require 2 or more people to move?
A. No

Q. Do any of your neighbors on your side of the street have water back up also?
A. Unknown

Q. Date of damage?
A. 26 czerwca 2021 10:00

Q. Is the Customer on the HDTAP List (Check the HDTAP Eligible list provided)
A. No

Q. Do you have a child under 10 in the house?
A. Yes

Q. Do you need cleaning sanitation services?
A. No

Q. Additional Information
A. Really need help replace my stuff that was water damage. My son room is in the basement he loss all of his stuff bed dresser clothes shoes. Washer and dryer