1 ABORN STREET 9-2-25 CLAIM GEICO Insurance Agency, LLC
Underwritten By:
Homesiote RECEIVED Homesite Insurance Company
Tel:1-866-372-8903
Fax:1-866-935-2858
unwwc Im"10"JCE
6000 American Parkway SEP 15 2025
Madison,WI 53783-0001
CITY OF SALEM
BOARD OF HEALTH Claim Number: 01-009-254011
Date Of Loss: 09/02/2025
002647FC6500MO1052541931 Q03A 001 Policy Number 36509731
SALEM CITY HALL Policyholder: Chantal C Coughlin And David G
93 WASHINGTON ST Hollinger
SALEM, MA 01970-3527
September 11, 2025
ATTENTION: Building Commissioner or Inspector of Buildings Fire Department or Arson Squad, Board of Health or
Board of Selectmen C/O City or Town Hall
NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 313
Our Insured: CHANTAL C COUGHLIN
Property Address: 1 Aborn St Salem, MA, 01 970-1 1 03
Policy Number: 36509731
Claim Number: 01-009-254011
Date of Loss 09/02/2025
N
This correspondence shall sere as notice that, pursuant to Massachusetts General Laws Chapter 139, Section
313, a claim has been made involving loss, damage or destruction to a building or other structure which may either
exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable.
C.
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C, If any notice pursuant to Massachusetts General Laws Chapter 139, Section 3B is appropriate, please direct such
notice to my attention and kindly, pursuant to the information provided above, include the insured's name, address,
policy number, claim number and date of loss. If you contact us via email, please use claimdocuments@afics.com
and be sure to reference the claim number in the subject line of your email.
Please contact me with any questions.
Sincerely,
( ; C��
Taaylor Cheatham
Desk Adjuster
AFICS on behalf of Homesite Insurance Company
Taylor.Cheatham @afics.com
Phone: 1-608-621-9656 1 Fax: 1-866-935-2858
Mail: 6000 American Parkway, Madison, WI 53783-0001
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