Acquired Structures - Intake Form

Montgomery County Fire & Rescue Service

Montgomery County, Maryland
Acquired Structure Intake Form
This form is to be used by all MCFRS personnel for notifying the PSTA of acquired structure leads. Please fill the form out in its entirety. The acquired structure manager (ASM) will contact you ASAP.
Today's date*

MonthDayYear
Date
Your Information
Name*

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.
Preferred method of contact*

EmailPhoneOther (please specify and provide)
Acquired Structure Information
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Year built*
How much time do we have until the property owner wants to tear down the structure/property?*

Within a month1-3 months3-6 months6-12 monthsGreater than 1 yearUnsure
Type of training*

Non-destructive (will cause no damage to the property)Destructive (will cause damage to the structure)
Property Owner*
Can be a specific person, LLC, foundation, etc.
Property Contact Information

The person we will primarily be communicating with to arrange inspections, execute the contract, etc.
Name*

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.
Any other comments or pertinent information that you would like to share?*
Should be Empty:

Montgomery County Fire & Rescue Service