NORTH CAROLINA DEPARTMENT OF CULTURAL RESOURCES
Office of Archives and History

STATE HISTORIC PRESERVATION OFFICE
RESTORATION BRANCH
4617 Mail Service Center, Raleigh NC 27699-4617

HISTORIC PROPERTY DAMAGE REPORT
Print out this form and fill in by hand to mail in. You may also email responses to these questions to hpo@ncdcr.gov

Date, type, and name of event (i.e., tornado, flood, Hurricane Isabel, etc.) _____________________________________

Name of Property: _________________________________________________________

Address: ______________________________________ Town/City/Vicinity: _____________________ County: ______________

In in a historic district, please name: ________________________________________________

Your Name: __________________________________________________________________

Your Address (if different from above): ____________________________________________

Telephone ______________________________________

Are you the owner of the property? ___yes  ___no.  If you are not the owner, please describe your relationship to the property and its owner:
_______________________________________________________________________

What kind of damage did the building(s) sustain?






Will all of your damage be covered by your insurance?




If not, approximately how much money do you estimate that you will have to spend out-of-pocket to repair the damage?



Can the State Historic Preservation Office be of some assistance to you in assessing damage and advising you on restoration and repairs?



Please send this form to the address below by mail or fax. If you prefer to e-mail your responses, please do so to hpo@ncmail.net.


Restoration Branch, State Historic Preservation Office
Raleigh Office:
919-807-6588 (phone)
919-807-6599 (fax)
4617 Mail Service Center
Raleigh, NC 27699-4617

Greenville Office: 252-830-6580 (phone)
252-830-6583 (fax)


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