Skip to Main Content
Loading
Close
Loading
Emergency Alert
Oak Fire Recovery Services
Read On...
Government
Our Community
How Do I
Visitors
Doing Business
Home
Forms
A
A
S.A.F.E. Application
Leave This Blank:
First Name:
*
Last Name:
*
Birthdate:
*
Physical Street Address:
*
Zip Code:
*
Mailing Address:
(if different than physical address)
Applicant's Contact Phone #:
*
Secondary Contact Phone #:
Email Address:
Person(s) to notify in an emergency:
Emergency Contact Phone #
PG&E Customer:
*
Yes
No
Primary Physician Name:
Physician Contact #:
Oxygen Service Company:
(if applicable)
Please write any additional important information you would like us to know in the event we have to contact you during an emergency situation. If you would like to include a list of your medications, feel free to do so in this box or on an attached separate piece of paper.
* indicates required fields.
Live Edit
Close
Budget
E-Services
County Email
EMPLOYEE INTRANET
- Intranet Instructions
Facilities Reservations
Jobs
Notify Me
Tax Payments
Online Bill Pay
Staff Directory
System Catalog
Tree Mortality Information
Mariposa County Recovers
Local Assistance Center Resources
Returning After the Fire
Debris Removal
Insurance
Vital Documents Recovery
Resources for Businesses Impacted
Donations
Wildlife and Domestic Animal Resources
Resource Contact Page
Frequently Asked Questions
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow