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Do you currently live in Louisiana and consider Louisiana to be your permanent resident?
Yes
No
Do you have a Louisiana driver’s license or state ID?
Yes
No
Are you over the age of 18?
Yes
No
Did you or someone you know suffer any of the following injuries or damages as a result of the loss of power (check all that apply)?
Personal Injury
Wrongful Death
Property Damage
Fire Damage
Other
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