This government document is issued by Maryland Department of Emergency Management for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:n_j4xw0tms8&q=https://mdem.maryland.gov/Documents/INSTRUCTIONS_FOR_PA_DAMAGE_ASSESSMENT_FORMS.pdf&sa=U&ved=2ahUKEwjb0PThmOeGAxVch_0HHX1_BkkQFnoECAgQAQ&usg=AOvVaw1Fq02-dE1Ce0clJLL_OMVl&arm=e&fexp=72519171,72519168