7 Nightingale Ln_ Claim w
TRAVELERSJ
CLAIM PROFESSIONAL
BRYAN BAKER
City of Salem Building Inspector
120 Washington Street
Salem, MA 01970
Claim Number
IMV4007
i
January 9,2023 l �
Dear City of Salem Building Inspector, Date of loss —li
I
To: Board of Selectmen January 1,2023
Building Commissioner
Inspector of Buildings
Board of Health
A claim has been made involving loss,damage or destruction of the above Q°
captioned property which may either exceed$1,000 or cause Massachusetts LOSS location
General Laws Chanter 143 Section 6 to be applicable.If any notice under
Massachusetts General Laws Chapter 139Section 313 is appropriate,please direct 7 NIGHTINGALE LN
it to my attention and include a reference to our insured,the policy number,the SALEM MA 01970
claim/file number,the date of loss,and the location.
Questions? Insured name: YEVGENIYA Y
KOTLERMAN
If you have any questions,please contact us. Underwriting THE STANDARD
Company: FIRE INSURANCE
On this date,I caused copies of this notice to be sent to the persons named above COMPANY
at the addresses indicated above by first class mail.
Signature Date
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