Natural Disaster Loss Information Sheet  

Please print and complete this form ASAP,  and return it to your county FSA office: 

OKEECHOBEE SERVICE CENTER        450 US HIGHWAY 98 N        OKEECHOBEE, FL 34972-2303
(863) 763-3345        (863) 763-6407 fax

Today's Date: __________________________        County:    __________________________

Disaster (name of hurricanes):  ____________________________  Date of disaster: ___________

Name: ________________________________        Address: ___________________________

Phone: ________________________________        __________________________________

Legal Description of your property ( See tax bill or plat book) ____________________________

Have you applied for assistance from the USDA/FSA in the past two years?  1 yes    1 no

Type of agricultural operation(s):  1 Dairy    1 Beef    1 Other Livestock    1 Grove    1 Nursery    1 Sod

1 Crops    1 Aquaculture    1 Equipment    1 Buildings/Structures    1 other - specify_____________

Please indicate Your loss/damage (include acres, animal units, type or variety, etc. )

Note:  Please keep your receipts for any repairs.  Also, keep a log of time used to complete your repairs.  Photographs are  a good source for proof/loss.  We may also need an inventory prior to the disaster and immediately after the event. 

This form is for internal use only - This is not an application for assistance.  This page has been posted to aid in Natural Disaster relief to local agricultural producers by the UF/IFAS Okeechobee County Extension Service.  UF/IFAS Extension does not provide financial assistance to growers nor is it responsible for establishing eligibility for these payments nor does it handle applications for assistance.   Trade names, where used, are given for the purpose of providing specific information. They do not constitute an endorsement or guarantee of products named, nor does it imply criticism of products not named. The Florida Cooperative Extension Service - Institute of Food and Agricultural Sciences is an equal opportunity/affirmative action employer authorized to provide research, educational information, and other services to individuals and institutions that function without regard to race, color, sex, age, handicap, or national origin.  Florida Cooperative Extension Service / IFAS / University of Florida.  Larry A.  Arrington, Dean This page is maintained by Dan Culbert