HomeMy WebLinkAboutMiscellaneous - 192 LACY STREET 4/30/2018 (2) 192 LACY STREET
2101105.C-0020-0000.0 7
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PO Box 55098
Boston,MA 02205-5088
617-951-0600
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
City Hall City Hall
NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845
RE: Insured: NATHAN L SMITH and GERILYN K SMITH
Property Address: 192 LACY STREET,NORTH ANDOVER, MA
Policy Number: HMA 0221777
Claim Number: BOS00049194
Date of Loss: 2/17/2015
Company: Safety Indemnity Insurance Company
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, 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 claim number.
Lindsey Hodgens Claim Examiner 2/18/2015
Safety Insurance Company
Homeowners Claims Unit
P. O. Box 55098
Boston, MA 02205-5098
Phone: (617) 951-0600 EXT 3418
Fax: (617) 603-4914
Email: LindseyHodgens@Safetylnsurance.com