Event Location/Date/Time
(* Required Data) Location

*County/Parish:	Counties ---AR counties--- Columbia Hempstead Howard Lafayette Little River Miller Nevada Sevier Union ---LA Parishes--- Bienville Bossier Caddo Caldwell Claiborne De Soto Grant Jackson La Salle Lincoln Natchitoches Ouachita Red River Sabine Union Webster Winn ---OK County--- McCurtain ---TX Counties--- Angelina Bowie Camp Cass Cherokee Franklin Harrison Gregg Marion Morris Nacogdoches Panola Red River Rusk Sabine San Augustine Shelby Smith Titus Upshur Wood
*Place(ex. 5 E Decatur):
*Date of Event: (MM DD YY)	Month / Day / Year
*Time of event: (HH MM)	Hour : Minute    AM or PM AM PM

Injuries? (Number) No Injuries No Injuries Yes Number of Injuries

Deaths? (Number) No Deaths No Deaths Yes Number of Deaths

Please describe any damage, injuries, and/or deaths related to this severe weather event or other needed details:

Comments

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Name (required) Name	Organization Organizations
Street address Street Address	City, State, ZIP City, State, ZIP
Phone (required) : ( Area Code ) Telephone Number - Number	E-mail address E-Mail
Are you a: (check one) (required) Spotter NWS Trained Spotter Public Public Citizen Law Enforcement Law/Public Safety Official Other Other (please explain): Other Emergency Manager Emergency Manager