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210/025.0-0016-0022.E
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Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department
John J. Pollard
Adjustment Service of Fitchburg, Inc.
P.O.BOX 1177 • LEOMINSTER,MA 01453 • TEL 508-840-8222 - FAX 508-8443637
Notice of Casualty Loss to Building
Under Massachusetts General Laws , Chapter 139, Section 3B
TO:
V Board of Health
Town of No. Andover
120 Main St.
No. Andover, MA 01845 RE: INSURED:
Lawrence & Julie Rosenblatt
Building Inspector
Town of No. Andover ADDRESS: 22 Alcott Way
120 Main St.
No. Andover, MA 01845 COMPANY: Pawtucket Mutual Ins. Co.
POLICY`: HX20565443-00
North Andover Fire Dept. LOSS OF: 7/3/92
124 Main St. LOSS BY: Wind/Water
No. Andover, MA 01845
A claim has been made involving loss , damage, or destruction of the above
captioned property, which may either exceed 1,000. , or cause Massachusetts
General Laws, Chapter 143, Section 6 to be applicable. If any notice un er
Massachusetts General Laws , Chapter 139, Section 3B is appropriate, please
ring it to our attention, and include a reference of the captioned
insured: location, policy number, and/or date of loss.
Respectfully,
JOHN J. POLLARD ADJUSTMENT SERVICE
OF FITCHBURG, INC.
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COMPLAINT NUMBER DATE:
#52— JUNE 16, 1992
COMPLAINTANT:JULIE ROSENBLATT CLOSE DATE:
ADDRESS:22 ALCOTT WAY PHONE: 689-9066
OWNER:LEO *BRASPKO[ e\i/
� PHONE #:
ADDRESS:ALCOTT VILLAGE/
INSPECTION DATE: ORDER L DATE:
COMPLAINT:OWNER OF PROPERTY IS NOT HAVING TRASH EMPTIED. BILLS HAVE NOT
BEEN PAID COMPANY WILL NO LONGER EMPTY TRASH.
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