42 MASON STREET_ NOTICE OF LOSS 7-17-25 THENORFOL%fjn DEDHAMGROUP®
Norfolk&Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
August 1, 2025
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
Board of Health or Board of Selectmen
c/o City or Town Hall -
93 Washington St.
Salem, MA 01970
Fire Department or Arson Squad
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
RE: Our File No.: SW
Insured: H REALTY LLC
C/O STEPHEN HALEY
Address: 42 MASON ST, SALEM, MA
Policy No.: D1982427A
Loss Date: 07/17/2025
Loss Type: Building or Other Structure Damage
A 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, Ch. 143, Sec. 6 to be
applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct
it to my attention and include a reference to the captioned insured, location, policy number, loss
date 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 the claim will be paid in our customary manner.
Sincerely,
Mike Dixon
FAST Property Claims Adjuster
1-800-688-1825 xnull ND
Home Office
222 Ames Street,P.O.Box 9109 SINCE 1825
Dedham,MA 02027-9109
Phone: (800)688.1825