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Form of Notice of Casualty Loss to Building
Under MASS. G15N. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
Town of N. Andover
N. Andover, MA 01845
To: Board of Health or
Board of Selectmen
Town of N. Andover
N. Andover, MA 01845
RE: Insured:
Property Address
Policy Number:
Date/Cause of Loss:
File or Claim Number:
Joseph & Judie Levis
1.88 Chestnut -St., N. Andover
HP 1481138
10/20/96 Water Damage
97-6331-W
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
GENERAL LAWS, CHAPTER 139, SECTION 313 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.
Wade Anderson, Adjuster
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.
wa -z,7 1
Signature and Date
HALLMARK CLAIM SERVICES, INC.
7 Lakeside Office Park, Wakefield, MA 01880