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Claim #:Property Damage Report Form Submit completed form to Office of the City Administrator 621 West Broad Street Suite 2B, Katakana, Ohio 43062 Date submitted:Name: Address where damage occurred: Description
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Submit completed form to the appropriate department or organization.
Anyone who needs to provide the information requested on the form.
Fill out the form with accurate and complete information.
The purpose of the form is to provide requested information.
Any information requested on the form must be reported.
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