HomeMy WebLinkAboutInsurance Letter - Correspondence - 14 CLARENDON STREET 8/8/2023 AHState Vehicle and Property Insurance Company
PO BOX 660636
Q40A 11 State.DALLAS TX 7,5266
YbuYe In good hands.
I-IIII 11111111111.111 11111111111111111111111111111111111111111111
TOWN OF NORTH AW)OVER TRCAST)RER COLLECTOR
120 MAIN ST
NORTH ANDOVE'R MA 01.3452420
August 14,2023
INSURED: KE.NNETI I BLACK PI-ONE, 603-340-0981
DATE OF LOSS: August 08,2023 FAX NUMBER: 866-447-4293
CLAIM NUMBER: 0724998546 DMM
PROPERTY ADDRESS: 14 CLARF,NDON ST,NORTH
ANDOVER,MA
POLICY NO.: 000925788596
Form of Notice of Casualty Loss,to Building
Under Mass.Gen.Lmvs.C'1'- I 39.Scc.3B
TO:
Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
CITY/TOWN HALL: Town Of North Andover
ADDRESS: 120 Main Street
CITY/TOWN/ZIP CODE I: North Andover, Ma 01845
Claim has been made involving loss,damage or destruction of the above-captioned properly which may either exceed
$1,000.00 or cause Mass. (sell. Laws,Chn,Aer�143,Secfion 6 to be applicable. 1 f7 any notice under Mass. C,ell.
1,aws,Chal)ter_I 39,Section 313 is appropriate,please direct it to the attention of the undersigned and include a
reference to the captioned insured, location, policy number,date of loss and claim number.
On this(late, 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'
MICHAEL MURPHY
August 14,2023
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