Flood Damage Report -- Due Sept 15 2009
Please fill out this form as best you can to help us determine the damages sustained by the Martins Pond Community in North Reading due to flooding. For each event please estimate your damages claimed to FEMA or your flood insurance carrier, and what was unclaimed.
This information will be used to support the efforts of the Town of North Reading to have the Rte. 62 Bridge replaced. Please enter any additional information below.
Thank you -- The Martins Pond Reclamation Study Committee and the Martins Pond Association

Flood Date	Total Damage	FEMA/Flood Insurance	Unclaimed	Check all that apply:
April 1987	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
August 1991	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
April 1993	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
October 1996	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
June 1998	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
March 2001	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
April 2004	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
June2005	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
May 2006	$________	$________	$________	Displaced ☐ Lost work ☐	Sandbagged ☐ Have receipts ☐
Other comments

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Name:________________________________________ Address:______________________________________ Signature:_____________________________________

Please print and mail to: Martins Pond Association c/o North Reading Town Hall 235 North St North Reading MA 01864