1. Name of County: {var County}
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2.
Type of Incident:
{var Type}
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3.
Beginning Date and Time of Incident:
{var BegTime}
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4.
Incident is: {var EventEnd} Ending
Date/Time: {var EndTime}
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5.
Description of Problem and Type of Assistance Needed
{var Problem}
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6.
Initial Assessment of Damage, Number of Injuries - Deaths
{var Initial}
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7.
List of Actions Pending or Taken by County and/or other Local
Governments
{var Actions}
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8.
Request Date and Time
- Form was Filled Out: {var DateTime}
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9.
Name of Authorizing Official (s):
{var Auth}
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