HomeMy WebLinkAboutMiscellaneous - 65 BLUE RIDGE ROAD 4/30/2018 65 BLUE RIDGE ROAD
210/065.0-0105-0000.0
I
SENDER: I also wish to receive the follow-
0 Complete items 1 and/or 2 for additional services. ing services(for an extra fee):
d Complete items 3,4a,and 4b.
`I ❑Print your name and address on the reverse of this form so that we can return this y
> card to you. 1. ❑Addressee's Address
d ❑Attach this form to the front of the mailpiece,or on the back if space does not
permit. 2. ❑ Restricted Delivery 0)
13 Write'Return Receipt Requested'on the mailpiece below the article number. Cn
❑The Return Receipt will show to whom the article was delivered and the date a
p delivered. .0)
0 3.Article Addressed to: 4a.Article Number
Q E
Q A
E 4b.Service Type
` m
W ❑ Registered ertified en
cn /►f/� ,G,�/ ❑ Express Mail ❑Insured S
LI-Return Receipt for Merchandise ❑COD
��v �r
D
a 7.Date of Delivery
z C
�/
5.R ceived By: (Print ame) 8.Addressee's Address(Only if requested and c
Wfee is paid) t
0 6.Signature(Addressee or Agent)
0
N
PS Form 3811,December 1994 102595-99-13-0223 Domestic Return Receipt
UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
• Print your name, address, and ZIP Code in this box • II
BOARD OF HEALTH
27 CHARLES STREET
N=ANDOVER,MA 01$43
. I
_............................-.........................-.....................-..._..............._......................................._---.............- ---
PATRICK J. DONOVAN ASSOCIATES, INC.
C'Iaim and XOSS .adjustments
P. O. BOX 110
WAKEFIELD, MA 01880
(617) 245.5540 — FAX (617) 245-7016
FEB I
February 8, 1997
Building Commissioner
City or Town Hall
N. Andover, MA 01845
Insured : Sheila A. Alvarez FILE
Property Address : 65 Blue Ridge Road
N. Andover, MA
Insurer : Patrons Mutual Ins. Co.
Policy Number HMA2025744
Type of Loss : Water
Date of Loss : 11/29/97
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.
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.
Signature
ASSOCIATION OF INDEPENDENT INSURANCE ADJUSTERS
ASSOCIAT04
WEPENOW
of Massachusetts "�`A"�
Addre s LU.S- a(CCE )` Title of Hie
Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of 6tefer to other
action Purpose of Document/Action and note
Document/ document/ s _
Num. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation COMM issi n —
o Building Department
