gas spill Reliance
Insurance
Companies
1776 Heritage Drive, P. O. Box 99, North Quincy, Massachusetts 02171 Telephone(617) 786-7800
APRI L 3, 1979
SALEM FIRE DEPT.
SALEM, MA
Claimant Insured Claim No.
KAREN M. MCCARTHY 001-79-0-28-16
Please help us in our investigation of this loss by supplying the following:
Traffic accident report .
Driver 1 Location
Driver 2 Date
Incident report X report Fire Marshall's
0
Complainant or Insured Location
KAREN M., MCCARTHY SALEM, MA
Type of Loss Date
FIRE 03/26/79
Recovery of stolen property
Please include any information about the identity or apprehension of anyone connected
with the incident and place this letter in your file for future reference.
Thank you
JUDI DIBONA
CLAIMS SERVICE REPRESENTATIVE
Claims Department
PLEASE DETACH AND RETURN WITH REPORT
Name of Representative Claim No.
JUDI DIBONA 001-79-0-28-1
Name of Insured
KAREN M. MCCARTHY
LC-5274 Ed.7/74
Reliance Insurance Company United Pacific Insurance Company Planet Insurance Company
Nt
CITY OF SALEM ALARM REPORT
incident..# Date
258— — o3- 2,6-1 '� U
Initial Report
Address ,�, .,� Type of Incident GI Td
ALARM TIME ASSIGNMENT METHOD RECEIVED
Still LS�/ Telephone
Box # Alarm Box 0
Special Call Police Dept. 0
2nd Alarm Citizen's Alarm [
3rd Alarm Private,Prot. Serv. 0
4th Alarm Fire Radio
5th Alarm Mutual Aid [�
Recall * Number Chronologically
Remarks and Equipment Used:
Foam 4 (Rev. /7s) Fire Alarm Operator
FIRE OFFICER'S REPORT
Type of Incident ,,
Probable-Cause /
i
Point of Origin Fiy9i�
(List room & floor location where possible)
How Occupied ;
(1 or 2 fam. dwelling; Apts.; Tenements;'Kind of store or factory)
Class of Building Stories
(Wood; stucco; stone; brick; aluminum)
Motor Vehicle: Year Make
Registration #
Owner L�N ;�,c r-,s ice/�' ,�.✓�y
Owner's Address 6 o grxcC 7-4w
Owner's Insurance
Tenant
Tenant's Ins.
Tenant
Tenant's Ins.
Tenant
Tenant's Ins.
Remarks & Injuries
Fire Officer in-Charge 4C.,itn
by Aide _ ,� .�Q