HomeMy WebLinkAboutCasualty Loss to Building Ch. 139, Sec. 3B - Miscellaneous - 21 ABBY LANE 6/22/2020 Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
120 Main Street
North Andover, MA 01845
RE: Insured: David & Karen Samenuk
Property Address: 21 Abby Lane
Company: Merrimack Mutual Fire Insurance Company
Policy/Claim Number: HP3170361, HP3170361
Date/Cause of Loss: 5/7/2020, Chimney Damage
Our File Number: 38160-D
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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 claim or
file number.
Daniel Paul, Ext. 117
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 and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Cc: Health Department
120 Main Street
North Andover, MA 01845
North Andover Fire Department
795 Chickering Road
North Andover, MA 01845