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Insurance Adjustment Service, Inc.
435 King St.
Littleton, MA 01460
(978) 952-6966
Fax (978) 952-2459
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B
Date: February 25, 2005
TO: Board of Health/Building Inspector
Town of N Andover
N Andover, MA 01845
RE: Insured: Brookside Homeowners Assoc.
Property Address: 636 Chickering Rd.
North Andover, MA 01845
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Date of Loss: 2/9/2005 WN �F NO PPR M�N�
10 N�p,�SN
Policy Number: CMN3981
Type of Loss: Ice dam
File or Claim Number: 21166
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. 38 is appropriate, please direct it to the attention of the
writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file
number.
cooperation.