HomeMy WebLinkAboutInsurance Letter - Correspondence - 16 CLEVELAND STREET 4/4/2024 ml'� RO `VIDENCE
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FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GENERAL LAWS, CH. 139 SEC. 3B
To : BUILDING COMMISSIONER OR BOARD OF HEALTH OR
INSPECTOR OF BUILDINGS BOARD OF SELECTMEN
TOWN CLERK'S OFFICE
120 MAIN STREET
NORTH ANDOVER, MA 01845
RE INSURED WAYNE P STANUCHENSKI
PROPERTY ADDRESS 16 CLEVELAND ST
NORTH ANDOVER, MA 01845
DATE OF LOSS 4/4/2024
CLAIM NUMBER 240000000851
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. INCLUDE A REFERENCE TO THE CAPTIONED INSURED,
LOCATION, DATE OF LOSS AND CLAIM OR FILE NUMBER.
SIGNATURE DATE
ON THIS DATE, I CAUSED COPIES OF THIS NOTICE TO BE SENT TO THE PERSONS NAMED ATTHE
ADDRESSES INDICATED ABOVE BY THE FIRST CLASS MAIL. j
ter, 2 . Ll-
SIGNATURE DA E
TELEPHONE (40.1) 8.2?:- 1 0 TOLL FRFE 1-877-763-'1 00 FAX (800) 3 s- 0 0
MAILING ADDRESS, P.O. BOX 6066, PROVID NNE, RI 02940
NO WOO TANT STA71 IN ORMAJ'10fV ON ��' PAC�kw A