HomeMy WebLinkAboutMiscellaneous - 75 COACHMANS LANE 4/30/2018 (2)O
tv
a
Cb -
Form o[ 1oke of Casualty Loss i:O 6UHM al— I f
Under Mas,,. Gen. Law3, Ci-,. i 39, t
-FO: Building 'Commissioner or
lrispecior of Buididings
addresseq
A.
Re: Insured: ---hA16t
Property address:__.
Policy INO. X, `7
Loss of
--7
File or Claim No. S /
2
Board ol' Hea-Iti'i or
Board o-; . Selectmen
Claim has been made 'Involving loss, Clarnage or destruction of the above captioned property, which
may either exceed $11,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be a!`Icab!e.
If any notice under Mass GenLaws, Ch. '139 See. 3B is apprqpr�,2te please diire-,-C it to the attention
Cf the and' include a reference to the capzioned insured, ocatiorj, pc'iicy num'.')er, da - e of 1c.) -ss
and claim or file riurnber.
On this date, I coosed copies of thig notice to bc 3cnt to the Persons at th.e addresses
,,ndicated above by first class mall.
Signature and (hto
01
, -fT;T-.
,k T-"
MASSACHUSETTS CONNECTICUT NEW HAMPSHIRE VERMONT MAINE RHODE ISLAND
Boston Lawrence Bridgeport Claremont Brattleboro Augusta Pawtucket
NA NAL
Barnstabic Pittsfield New Lindon Gorham Burlington Lewiston ASS00 Tpad
CLAWC 211tvIct or Brockton Salem No. Haven Laconia Montixlier Skowhegan NEW YORK
NIV ZKOLAND. INC. Fall River Springfield Stamford Manchester White River Jet. S. Portland Utica
Fitchburg Worcester Waterbury PoFtSMOULli
W. Hartford
1 11