HomeMy WebLinkAboutMiscellaneous - 137 BERKELEY ROAD 4/30/2018 Emir_ 137 BERKELEY ROAD 1
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, See. 3B
TO: Building Commissioner 0 Board of Health or
1 0
Inspector of Buildings Board of Selectmen
Town of N. Andover ) ( Town of N. Andover _
III )
addresses
N. Andover, MA 01845 ) ( N. Andover, MA 01845
)
RE: Insured: Ronald & Lois Ponikvar
Property address: '137 Berkeley Road
N. Andover, MA
Policy No. HP1087743
Loss of 4/9/92 19 III
File or Claim No. WAP14325 Vehicle Damage
Claim has been made involving loss, damage or destruction of the above-captioned
property, which may either exceed $1,000.00 or cause MASS. GEN. LAWS, CHAPThR 143,
SECTION 6, to be applicable. If any notice under MASS. GEN. LAWS, CH. 139, SEC. 311
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 claim or file number.
Adjuster
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.
PATRICK J. DONOVAN ASSOCIATES, INC. IJUtin4%22/92 _
P.O. BOX 110 Signature and date
WAKEFIELD, MA 01880