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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
BUILDING COMMISSIONER OR
INSPECTOR OF BUILDINGS
North Andover Town Hall
North Andover, MA 01845
BOARD OF HEALTH OR
BOARD OF SELECTMEN
North Andover Town Hall
North Andover, MA 01845
RE: Insured: Jean L Gray
Property Address: X96 Marblehead Road
North Andover, MA 01845
Policy Number: HOS8504347
Date/Cause of Loss: 8/1 "1 - Windstorm
File or Claim No: 92621-P
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. 313 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.
Clay Pluff, General Adjuster
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.
Signatur6)nd Date
- HALLMARK CLAIM SERVICES -
Lakeside Office Park, Door 17, Wakefield, MA 01880