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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec..3B
To: Building Commissioner or
Inspector of Buildings
North Andover, MA
RE: Insured: Samantha Smith
Property Address: 43 Cochichewick Drive, #14, N. Andover, MA i
Policy Number: 3086229
Date/Cause of Loss: 2-7-15/Ice Dam i
File or Claim Number: BOS53804 i
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS,
CHAPTER 139, SECTION 36 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.
Joseph Lantieri
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
3/27/15
)SWigture an ate
NEW ENGLAND CLAIMS SERVICE, INC.
131 DODGE STREET, SUITE 6
BEVERLY, MA 01915
I
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
North Andover, MA
RE: Insured: Samantha Smith
Property Address: 43 Cochichewick Drive, #14, N. Andover, MA
Policy Number: 3086229
Date/Cause of Loss: 2-7-15/Ice Dam
File or Claim Number: BOS53804
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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 or
file number.
i
Joseph Lantieri
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
I
3/27/15
nat a and Date
NEW ENGLAND CLAIMS SERVICE, INC.
131 DODGE STREET, SUITE 6
BEVERLY, MA 01915
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