2. Name*
3. Email Address*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number*
13. Incident Type*
    -- Select One --Fire Loss - HouseFire Loss - Outbuilding/Other StructureFire Loss - VehicleFire Loss - Crops/VegitationVehicle Collision
14. Date of Incident*
    Date of Incident
16. Address of Incident*
18. Special Notation
    Estimates for property value and loss for homes and structures are obtained from the Effingham County Tax Assessor. Estimates for property value and loss for vehicles, machinery, or equipment are obtained from reputable vendors specific to their field. All estimates are strictly for the purpose of the fire department and do not reflect contents, insured property, or claims/settlement amounts.
20. Terms and Conditions for Open Record Requests
    By submitting this form, you are acknowledging the terms and conditions required: I understand that, pursuant to O.C.G.A.§ 50-18-71, I may be charged administrative and copying fees for the cost to search, retrieve, copy and supervise access to the requested documents. This fee represents the hourly rate of the lowest paid full-time employee with the necessary skill and training to respond to my request, with no charge for the first thirty minutes that it takes to respond to the request. The charge for copies is generally $.10 per page unless otherwise provided by law. I agree to pay all copying and/or administrative costs incurred with fulfilling my open records request.
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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