HomeMy WebLinkAboutMiscellaneous - 116 MASSACHUSETTS AVENUE 4/30/2018 ` er
116 MA55AGHUst I I s Hvtrvuc Ave. l
210/006.0-0008-0000.0 '
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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
2 CENTER PLAZA
BOSTON, MASSACHUSETTS 02108-1904
800-392-6108 617-723-3800
DATE 01/08/98
Form of Notice of Casualty Loss to Building
Under Mass . Gen. Laws, Ch. 139, Sec . 3B
TO: NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALLTOWN OF NQS N®o _
NORTH ANDOVER MA 01845 BOARD OF HEALTH
i
`, ► - � 1998
RE: Insured: CATHERINE O' SULLIVAN
Property Address : 116 MASS . AVE.
NO. ANDOVER MA 01845
Policy Number: 20-2-437737-00
Type of Loss : CRACKED BOILER Date of Loss : 01/07/98
Claim Number: 20-2-0163684
Claim has been made involving loss, damage or destruction of the
above-captioned property, which may either exceed $1, 000 . 00 or cause
Massachusetts General Laws, Chapter 143 , Section 6 to be applicable .
If any notice under Massachusetts Genera Laws, C a ter 139, Section 3B
is appropriate, please direct it to the attention o the writer an
include a reference to the captioned insured, location, policy number,
date of loss and claim or file number.
MPIUA Claims Division
MUA-CL-21
TOWN OF NORTH ANDOVER!
BOARD OF HEALTH
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MASSACHUSETTS.PROPERTY INSURANCE
FAIR PLAN UNDERWRITING ASSOCIATION
Three Center Plaza
Bostun, .Wassachusetts 02108
(617) 723-3300
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws , Ch. 139, Sec. 3B
TO: Building Commissioner or Board .cf Health or Fire Department cr
Inspector of Buildings Board of Selectmen Arson Squad
RE: Insured: �
Property Address:
Policy Number: 34? &el �11
Loss of 19 70'
' File or Claim Number(s): /11?1 L Aj fil
Claim has been made involving loss , damage or destruc:ion'of tce above-
cautioned property, which may either exceed 51,000.00 or cause Massac se::s
General Laws, Chao-ter 143, Section 6 to be applicable. If anv notice unduer
Massachusetts General Laws, Chaoter 139. Section 3B is aoprooriate , piease
direct it to the attention of the writer and include a reference to the captioned
insured , location, policy number, date of loss and claim or ;ile number.
'(Signature) s
Title:
On ;cis date, I caused copies of this n6tice to be sent,_o _`:e person :tamed
zco•:e at the addresses indicated above by ;irst class Nail:
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