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PATRICK J. DONOVAN ASSOCIATES, INC.
"CLAIM AND LOSS ADJUSTMENTS"
P. 0. Box 110
Wakefield, MA 01880
(617) 245-5540
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FORM OF NOTICE OF CASUALTY LOSS TO BUILDIN NOFRpOFN� 0� ��
UNDER MASS. GEN. LAWS. CHP. 139, SEC. 3 �OV� pr
TO: Building Commissioner or
Inspector of Buildings
City or Town Hall
N. Andover, MA 01845
RE: Insured: Rose & Ronald Landry
Property Address: 121 Berkeley Road
N. Andover, MA 01845
Policy Number: DW950023
Loss. Type: - Vehicle Damage
Date of Loss: January 3 , 1996
Our File Number; WAP 21917
Claim has been made involving loss, damage or destruction of the above-
captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws,
Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen.
Laws, Chapter 139, Section 3B is appropriate, please direct it to the
attention of the writer and include a reference to the captioned Insured,
location, policy number, date of loss and file number.
Vern Laws, Adjuster
Donovan Associates, Inc.
Wakefield, MA 01880
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.
February 5, 1996