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PATRICK J. DONOVAN ASSOCIATES, INC.
"CLAIM AND LOSS ADJUSTMENTS"
P.O. Box 110
Wakefield, MA 01880
(617) 245-5540
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS. CHP. 139, SEC. 3B
TO: Building Commissioner or
Inspector of Buildings
City or Town Hall
N. Andover, MA 01845
RE: Insured: Jerome S. & Donna K. Warren
Property Address: 64 Blue Ridge Road
N. Andover, MA
Policy Number: HP 1505869
Loss Type: Water
Date of Loss: 2/14/94
Our File Number: WAP18150
Claim has been made involving loss, damage or destruction of the above-
captioned property, which may either exceed $1, 000 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, policy number, date of loss and file number.
zJW . T(La-��
D. . Monaco, Adjuster
Donovan Associates, Inc.
Wakefield, MA
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.
March 25, 1994
LaMarche Associates
233 West Central-Street
P.O. Box 179
Natick, MA 01760
(508) 650-9777
Fax: (508) 650-9870
December 17, 1996
Building Commissioner/Inspector of Buildings
N. Andover,MA 01845
Board of Health/Board of Selectmen
N. Andover, MA 01.845
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS,CHAPTER 139, SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, 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 313 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,cause of loss and LA
file number.
Insured: CHAPMAN STEPHEN&DONNA
Loss Location: 64 Blue Ridge Rd
N. Andover, MA 01845
Policy Number: HP222080
Date of Loss: 10/20/96
Cause of Loss: Property
LA File Number: MA-2-12706
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.
Daniel Johnson
Adjuster
LaMarche Associates
233 West Central Street
P.O. Box 179
Natick, MA 01760
(508) 650-9777
Fax: (508) 650-9870
December 17, 1996
Building Commissioner/Inspector of Buildings
N. Andover, MA 01845
Board of Health/Board of Selectmen
N. Andover, MA 01845
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS,CHAPTER 139, SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, 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,cause of loss and LA
file number.
Insured: CHAPMAN, STEPHEN & DONNA
Loss Location: 64 Blue Ridge Rd
N. Andover, MA 01845,
Policy Number: HP222080
Date of Loss: 10/20/96
Cause of Loss: Property
LA File Number: MA-2-12706
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.
Daniel Johnson
Adjuster
Address ��U 2
ress � i bar Eo Title of File
Page of
Date File Open: Date file closed:_
Doc Document/Action Title Date of Refer to other Purpose of pocumernt/Action and
action Document/ document/ notes
fWum. Action Department
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