Hope Desoto Long Term Recovery Group Inc.
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Community Needs Assessment - Milton
Full name: first and last *
Email address *
Primary physical address *
Primary phone Number *
Currently displaced / not living in primary residential home property *
yes
no
Cost of damages of electric appliances (estimates) *
Cost of damages to gas appliances (estimates) *
Damages to gas oven *
yes
no
Damages to gas stove *
yes
no
Damages to electric oven *
yes
no
Damages to electric stove *
yes
no
Damages to clothes dryer *
yes
no
Damages to clothes washer *
yes
no
Damages to dish washer *
yes
no
Damages to refrigerator *
yes
no
Damages to freezer *
yes
no
Damages to hot water heater *
yes
no
Damages to furnace *
yes
no
Damages to central a/c unit *
yes
no
Damages to window a/c unit *
yes
no
Damages furniture in residence *
yes
no
Damages to couch, love seat, sectional *
yes
no
Damages to tables: dining, kitchen, side, coffee *
yes
no
Damages to chairs: dining chairs, rocking chairs, recliners *
yes
no
Damages to dressers: chest of drawers, kids dresser, tall boy, dry sink *
yes
no
Damages to beds: primary bedframe, child's bedframe, guest room bedframe *
yes
no
Cost of damages to furniture: couches, tables, chairs, bedframes (estimates) *
Damages to TVs *
yes
no
Cost of damages to TVs (estimates) *
Damages to chimney *
yes
no
Cost of damages to chimney (estimates) *
Damages to exterior doors *
yes
no
Cost of damages to exterior doors (estimates) *
Damages to interior flooring *
yes
no
Cost of damages to flooring (estimates) *
Damages to foundation *
yes
no
Cost of damages to foundation (estimates) *
Damages to interior doors *
yes
no
Cost of damages to interior doors (estimates) *
Damages to mobile home skirting *
yes
no
Cost of damages to mobile home skirting (estimates) *
Damages to outbuildings: barns, sheds, coops, pump house, dog house *
yes
no
Cost of damages to outbuildings (estimates) *
Damages to plumbing *
yes
no
Cost of damages to plumbing (estimates) *
Damages to roof *
yes
no
Cost of damages to roof (estimates) *
Damages to walls *
yes
no
Cost of damages to walls (estimates) *
Damages to windows *
yes
no
Cost of damages to windows (estimates) *
Damages to ceiling *
yes
no
Cost of damages to ceiling (estimates) *
Construction of residential home property *
concrete block
mobile
pre-fabricated
wood frame
other
Square footage of residential home property *
Leave this field empty
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