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BUTTERWORTH & O'TOOLE, INC.
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
NEWTON OFFICE SALEM OFFICE
P.O.BOX 238, NEWTONVILLE,MA 02160 P.O. BOX 8294, SALEM, MA 01971-8294
TELEPHONE (617) 969-6370 *'"` r Q TELEPHONE (508) 741-5731
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FAX (617) 969-3135 ��••, , FAX (508) 740-9109
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FORK OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER KASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of He h or
Inspector of Buildings Board of Selectmen
Town Hall ) ( Town Hall
Addresses
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RE: Insured: r / / 4're,
Property Address: N5�'
Policy No. :
Loss of•
File or Claim No. : Gov 7
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1, 000. 00 or cause Hass. Gen.
Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass.
Gen. Laws, Ch. 139, sec. 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 claim or file number.
If no reply is received from your office within ten days, we will
assume you have no liens of any type against this property and we will
recommend to the insuring company that this claim is paid.
- - Adjuster
JUN 14 M,1
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