HomeMy WebLinkAboutInsurance Corespondence - Correspondence - 58 PALOMINO DRIVE 11/18/2020 it
Northeast: property MC'0
P.O. BOX 660636
(WAIISMM-DALLAS TX 75266
You're In good hends.
Hill,ililllll�llll�ll�ili�Jill]liilillErillilnlllir�illlilkl�
RECIPIENT OF ORIGINAL
TOWN OF NORTH ANDOVER TREASURER COLLECTOR DEBORAH AND DR
RAFFALLI
120 MAIN ST 58
NORTH ANDOVER MA 01.845242.0 NORTH ANDOVFR MA 018453377
COPY OF ORIGINAL
i
November 18,2020
INSURED: DEBORAH RAFI�ALLI PHONL NUMBER: $00 280-071d
DATE OF LOSS: November 09,2020 FAX NUMBER: 866-447 4293
CLAIM NUMBER: 0606123636 RAG OFFICE HOURS: Mott - Fri 8:00 ant -5:30 pill,
PROPERTY ADDRESS: 58 PALOMINO DR,NORTH Sat 8:00 ant -2:00 pill
ANDOVER,MA
POLICY NO.: 00092.563388E
Form of Notice of Casualty Loss to Building
Under maSS.Ge1t.LaNvs.Ch 139.Sec.3R
`1'O:
Building Commissioner,or Board of Health or
Inspector of BuildingsBoard of SelecUnett
CITY/TOWN MALL: TOWN OF NORTH ANDOVER
ADDRESS: 120 MAIN STREET
Ci'I'Y[I'OWN/LIP CODE: NORTH ANDOVER, MA 01845
Claim itas been made involving loss, damage or destruction of the above-captioned property which tray either exceed
$1,000.00 or cause Mass Cent Laws,Chatter 143 Section 6 to be applicable. (Fatty notice under Mass.Geri. Latvs,
Lila tier 139 Section 313 is appropriate,please direct it to the attelttion of the undersigned and include a reference to the
captioned insured, location, policy number,date of loss and claim rturnber.
On this date, 1 caused copies of this notice to be sent to the persons ranted above at the addt esses indicated above by
first class mail.
SIGNATURE AND DATE
AARON CUMMINS
November 18,2020
Copy : TOWN OF NORTH ANDOVER TREASURER COLLECTOR
E'R011054 r .
300002020111BT14010000835001001001212
