HomeMy WebLinkAboutMiscellaneous - 25 CARRIAGE CHASE 4/30/2018 (5)Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B � `=
TO: Building Commissioner or Board of Ilealth or
Inspector of Buildings Board of Selectmen
Town of N. Andover ) ( Town of N. Andover
) (
addresses
N. Andover,_ MA 01845 ) ( N. Andover, MA 01845
) (
IIE: Insured: V. Scott Follansbee
Property address: 25 -Coo-t=�hase Road S tom( i-� p00 dxgz1.
No.
Loss of
File or Claim No.
North Andover, MA 01845
HP 0942853
April 13,
WAP 16460(water)
19 93
Claim has been made involving loss, damage or destruction of the above-eapt.ioned
property, which may either exceed $1,000.00 or cause MASS. GEN. LAWS, CIIAPTER 143,
SECTION 6, to be applicable. If any notice under MASS. GEN. LAWS, CII. 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.
Adjuster
Title: --
On this date, I caused copies of thio notice to be sent to the persons named above
at the addresses indicated above by first class mail.
PATRICK J. DONOVAN ASSOCIATES, INC. (�
P. 0. BOX 110 7/28/93
(__ v
WAKEFIELD, MA 01880 Sim qtbre and' late