9 CHANELLE CIR_ NOTICE OF LOSS 6-20-25 , ....- � underwritten By:
STREET Main Street America Assurance Company
Tel: 1-800-258-5310
AKA
s c^ Fax: 1-866-935-2858
INSUMWE
6000 AMERICAN PARKWAY
MADISON,WI 53783-0001
Claim Number: 01-009-299844
007508FC6500M01052731502 Q03A 001 Date Of Loss: 06/20/2025Policy Number: 51 J2171V
r SALEM CITY HALL Policyholder: Keith Legget
93 WASHINGTON ST
SALEM, MA 01970
September 30, 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 3B
Our Insured: Keith Legget
Property Address: 9 Chanelle Cir Salem, MA, 01970-4592
o Policy Number: 51J2171V
Claim Number: 01-009-299844
Date of Loss 06/20/2025
r
0
This correspondence shall serve 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
S exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable.
0
0
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,
Ye&?
Yvette Toledo
Desk Adjuster
AFICS on behalf of Main Street America Assurance Company
Yvefte.Toledo@afics.com
Phone: 1-608-621-9768 1 Fax: 1-866-935-2858
Mail: 6000 American Parkway, Madison, WI 53783-0001
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