Get Emd 086 Form

The Emd 086 Form is essential for individuals seeking to claim reimbursement for property loss or damage incurred during their service as Emergency Workers. This guide provides clear instructions on how to complete the form online efficiently and accurately.

Follow the steps to complete the Emd 086 Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the name of the claimant in the designated field. Ensure that both first and last names are provided, along with the middle initial if applicable.
3. Enter the emergency worker card number correctly to authenticate your identity.
4. Specify the county where you are registered as an emergency worker in the appropriate space.
5. Provide the claimant’s address, including city, state, and zip code, along with home and work phone numbers.
6. Include the claimant's social security number or tax ID number which is essential for processing the claim.
7. Document the county where the incident took place as well as the mission or incident number and date of the incident.
8. State the total amount claimed, ensuring that all amounts are accurate.
9. Describe the items lost or damaged with as much detail as possible, including the model, style, type, or any other relevant descriptions.
10. Record the date of purchase or acquisition of the items, the original cost, and the total current value of items claimed.
11. Provide a comprehensive description of the circumstances surrounding the loss or damage. Use additional sheets if necessary.
12. Indicate whether the loss or damage was covered by private insurance and, if so, detail the insurance company’s name, address, and policy number.
13. Answer the questions regarding deductibles and claims made against the insurer with appropriate details.
14. Ensure that the form is signed by the claimant or their legal representative and includes the date and place of signing.
15. After filling out the form, review all entries for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your Emd 086 Form online today to ensure your property loss claim is processed promptly.