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1 ABORN STREET_ NOITICE OF LOSS 9-2-25 HomesiteGEICO Insurance Agency, LLC Underwritten By. NO ME 1 Homesite Insuran a company NSURgNCE 6000 American Parkway Tel:1-866-372-8903 Madison,WI 53783-0001 Fax: 1-866-935-2858 000090FC6500M01052541931 Q03A 001 Claim Number: r,. SALEM CITY HALL Date Of Loss: 01-009-254011 Policy Number: 09/02/2025 93 WASHINGTON ST Policyholder: 36509731 Chantal C Coughlin And David G SALEM, MA 01970-3527 Hollinger September 11, 2025 ATTENTION. Board of Selectmen /O Clay o Town Halle Bu"Pgs Fire Department or Arson Squad, Board of Health or Our Insured: NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 3B Property Address: CHANTAL C COUGHLIN 3 Policy Number: 1 Aborn St Salem, MA, 01970-1103 Claim Number: 36509731 n Date of Loss 01-009-254011 09/02/2025 This correspondence shall serve as notice that, pursuant to Massachusetts General Laws Chapter 139, Section 3B, 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. ' n If any notice pursuant to Massachusetts General Laws Chapter 139, Section 36 is appropriate, please direct such notice to my attention and kindly, providedon Policy number, claim number and date of loss•If YOU conthe act us va email, Pleaseluse cllaimdocume is@af cs.com and be sure to reference the claim number in the subject line of your email. Please contact me with any questions. i Sincerely, (" C&Aft Taaylor Cheatham Desk Adjuster AFICS on behalf of Homesite Insurance Company Tayior.Cheatham@afics.com Phone: 1-608-621-9656 1 Fax: 1-866-935-2858 Mail: 6000 American Parkway, Madison, WI 53783-0001 Page i o11