MERIDIAN LAW GROUP

Justice - Excellence - Integrity

Flood / Sewage-Backup Victim Intake Form

We took it upon ourselves to hold ourselves as a resource to potential flood claimants. We can help you submit your claim to the City. It will be some time until we know for sure who, if anyone was legally at fault for the flooding. If the government (CITY, COUNTY, etc.) was at fault, claimants who retain us will be at a distinct advantage because they will be more likely to get a solid settlement offer for their property damages.

Please fill out the following form completely for a free review and consultation. Please also document all of your damages as thoroughly as possible, including pictures, if and when possible.

DISCLAIMER: Filling out the following form does not constitute a retainer for legal services. Please seek help in emergency, and continue seeking remedy from your insurance company and other available resources.


Flood Intake Form

Please fill out the following form completely for a free review and consultation. Please also document all of your damages as thoroughly as possible, including pictures, if and when possible. DISCLAIMER: Filling out the following form does not consitute a retainer for legal services. Please seek help in emergency, and continue seeking remedy from your insurance company and other available resources.


GENERAL INFORMATION (THIS SECTION MUST BE COMPLETED)

Claimant Name:
Date of Birth::
Complete Address::
City:
State:
Zipcode:
Phone Number::
Email Address::
Last four digits of social security number::
Incident location::
Incident date::
Name/address/phone numbers of any witnesses, if any::
Briefly explain what happened::
Did you sustain property or personal property damage ? ONLY Fill Out The Section Below If You Have Sustained Property Damage::
Are you the property owner? If no, list property owner contact information::
Are you a tenant leasing or renting the property::
Did Your home suffer flooding on August 11, 2014?
Did you file a claim with the City within 45 days?:
Did any of your neighbors also flood?:
How many inches of water did you have at your home?:
When did the water leave your home?:
Do you have homeowners/renters insurance:
Did you file a claim with your insurance company::
Please briefly list any other information not provided for in the above sections that you think will aid the City in processing your claim: