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Damage Assessment Form-Business

  1. GSEM-Logo-sm.png

  2. Owners information

  3. Leased Space

  4. If space is leased what business currently occupies location.

  5. Estimated Pre-Disaster Fair Market Value of Business

  6. Estimated dollar amount of damage to structure

  7. Estimated dollar amount of furnishing/inventory loss

  8. i.e. fire, smoke, flooding

  9. If different from business owner

  10. Leave This Blank:

  11. This field is not part of the form submission.