HomeMy WebLinkAboutMiscellaneous - 99 MIDDLESEX STREET 4/30/2018 (5)v
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
TO:. Building Commissioner or
Inspector of Buildings
Town of N. Andover )
)
N. Andover, MA 01845 )
Board of Health or
Board of Selectmen
( Town of N. Andover
addresses
( N. Andover, MA 01845
RE: Insured: Thomas J. & Marilyn C. Licciardello
Property address: 99 Middlesex Street
N. Andover, MA
Policy No. HP1028587
Loss of
File or Claim No.
3/2/92
WAP14161 Fire
19
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. 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 claim or file number.
Adjuster
Title:
On this date, I caused copies of this nmice to be sent to the persons named above
at the addresses indicated above by first class mail.
PATRICK J. DONOVAN ASSOCIATES, INC. - 6/3/92 _
P.O. BOX 110 Signatfire and dldte
WAKEFIELD, MA 01880