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Name
Location/City
phone number
email address
Address Where The Fire Loss Occured
Was your home or property burned by the Panhandle fires?
Yes
No
Did you lose livestock by the Panhandle fires?
Yes
No
Was your place of business or goods related to your business, and/or equipment, burned by the Panhandle fires?
Yes
No
Did you or anyone on your property suffer from physical injuries during the Panhandle fires?
Yes
No
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