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Claim # 2591065
Advantage Claim Services Adjuster Assigned: Glenn Guarente
522 Chickering Road #B
North Andover, MA 01845
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
Town Hall
North Andover, MA 01845
Re: Insured: Anthony S. Conte
Property address: 236 Johnson St.
North Andover, MA 01845
Policy#: 2591065
Loss of: 2011/10/29
File. or Claim No. AD 9661
Board of Health 4X
Board of Selectmen
Town Hall
North Andover, MA 01845
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,_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.
a
Glenn Guarente
Title: Adjuster
On this date, I caused copies of this notice to be sent to the persons
named at the addresses indicated above by first class mail.
11-14-11
Signature and date