11 WOODLANDS ROAD 12-25-24 CLAIM P.O. Box 2487
Woburn, MA 01888
P: (781) 755-8554
F: (781) 757-0885
claims@benchmarkclaims.com
12/26/2024
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
City of Salem
City Hall
Building Inspector
Salem, MA 01970
City of Salem
City Hall
Health Inspector
Salem, MA 01970
Salem Fire Department
Salem, MA 01970
Insured: Jonathan & Jayne Barrrett
Address: 11 Woodlands Road, Salem, MA 01970
Policy No.: 13215115
Date of Loss: 12/25/2024
Origin: Water
Our File No.: 24-514 -BS
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. 3B 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.
If no reply is received from your office within ten days, we will assume you have no liens of any
type against this property and we will recommend to the insuring company that this claim is
paid.
Sincerely,
Brad Doherty
Brad Doherty
Owner