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NO.. 742 742 :
7750' Triton
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38. Street, Methuen , Mass.
Tel. 687- 3828
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THAT T/-/E SYSTEM WILL FUiVCT/O/V PR�PER�Y.
Metropolitan
Property and Liability Insurance Company
and Subsidiaries
0
'DOWN OF NORTH ANDOVER
BUILDING INSPECTOR
E4 NORTH ANDOVER, MASS 01845
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
r • rLL )
64
addresses
RE: Metropolitian insured: LOREN G MARY D CARLSON
Property address:,-117 BRIDLE PATH
NORTH ANDOVER, MASS
Policy Number: H 0953293 65 0
Loss of VEHICLE DAMAGE 05/06/91
mm/dd/yr
Claim Number: WB082014L A
Metrcpolitain has received a claim involving loss, damage, or
destruction of the above-indicated property, which may either exceed
$1,000 or cause Massachusetts Gen. Laws, Chapter 143, Section 6,
to be applicable. If any notice under Massachusetts Gen. Laws,
Chapter 139, 3B is appropriate, please direct it to the attention
of the undersigned and include a reference to the captioned insured,
location, policy number, loss date, and claim number.
C.R.
Title
On this date, I caused copies of this notice to be sent to the persons
named above at the addresses indicated above by first class mail.
CAROL L. MILLER 5/7/91
Signature Date r_ �
SEND TO BUILDING COMMISSIONER OR INSPECTOR OF BUILDINGS
MAY
NPL 3375-000
MPL 9192-000 Printed in U.S.A.0588