HomeMy WebLinkAboutMiscellaneous - 57 BERKELEY ROAD 4/30/2018 (2) 57 BERKELEY ROAD
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GEORGE O. LEWIS CO., INC.
Insurance Adjusters
2 hi n't 2 North Main Street
Ipswich, Massachusetts 01938
(617) 356 2952
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws, Ch. 139, Sec.3B
TO: Building Commissioner or Bo d of Health or
Inspector of Buildings and of Selectmen
Building Inspector ) Board of Health
( FILE
North Andover, MA 01810 ) addresses North Andover, MA 01810
RE: Insured: Andrew g_ it Lynna janknhRk
Property Address: 57 Berkeley Road, North Andover, N&
Insuror and Policy Number: Massachusetts Bay Insurance Co._
Policy # HVN 0055994
Date of Loss: 12/25/83
Insuror' s Claim Number:
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, insuror
and policy number, date of loss and claim number.
/f Adjuster
On this date, I caused cop es of this notice to be sent to
the persons named above at the addresses indicated above by
first class mail.
/6 - f Signature
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Page of
Date File open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of rnecnt/Action annotes
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Num. Document/
Department
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