HomeMy WebLinkAboutMiscellaneous - 80 MILLPOND 4/30/2018 (2)nt Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
To: ul ding Commissioner or
Inspector of Buildings
Board of Health or
Board of Selectmen
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addresses
Re: Insured:
Property address:
Policy No. I V—��i5����
Loss of 0 19
File or Claim No. a
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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, Ch. 139 Sec. 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
and claim or file number.
Title:O
On this date, I caused copies of this notice to b ent to the p rsons na ed above at the addresses
indicated above by first class mail.
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MASSACHUSETTS CONNECTICUT
NEW HAMPSHIRE
VERMONT MAINE RHODE ISLAND
Boston Lawrence Bridgeport
Bomstable Pittsfield New London
M5cuuwsssvtcs of Brockton Salem No. Haven
31a sttawto, tMe. Fall River Springfield Stamford
Fitchburg Worcester Waterbury
W. Hartford
Claremont
Gorham
Laconia
Manchester
Portsmouth
Brattleboro Augusta Pawtucket
Burlington Lewiston
Montpelier Skowhegan NEW YORK��+►
White River Jet. S. Portland Utica
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