Form K - Casualty Loss Form - State Of Indiana printable pdf download

Form K - Casualty Loss Form - State Of Indiana

Casualty Loss Form

Form K

1. DEVELOPMENT INFORMATION

DEVELOPMENT NAME:

BUILDING IDENTIFICATION NUMBER (BIN):

HOME/DEVELOPMENT FUND AWARD NUMBER (IF ANY):

DATE OF CASUALTY LOSS:

a. Property Address:

City:

State:

Zip Code:

Phone: (

)

b. Management Company:

Contact Name:

Address:

City:

State:

Zip Code:

Phone: (

)

Email:

c. Owner Name:

Owner Contact:

Address:

City:

State:

Zip Code:

Phone: (

)

Email:

d. Number of buildings effected:

Number of Units effected:

BINs of Units effected

Please include a list of unit numbers effected and identify tenant relocation and

rehabilitation plans with the submittal of this Form

Casualty Loss Cause Information

Place the date of the occurrence in the Text box, and for “Other” identify the cause and the

date.

a. Fire:

b. Tornado:

c. High Winds:

d. Flood:

e. Other:

Date:

Cause:

Name of Emergency Response team who responded

Please include a report, from the emergency response team, with the submittal of this Form

State of Indiana Casualty Loss Form K

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Form K - Casualty Loss Form - State Of Indiana

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