INS CLAIM LTRRJS
ROBERT J. SWAJIAN & ASSOCIATES, INC. N
T;
INSURANCE ADJUSTERS
SYOCttKA+,
1820 TURNPIKE STREET-STE. 207
N. ANDOVER, MA 01845
TELEPHONE(978)655-4994
FAX(978) 655-3571
Info(a)RJSAssociates.biz
FORM OF NOTICE OF CASUALTY LOSS
TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectman
Inspectional Services
SALEM, MA 01970
RE:Our File No:18-32344
Insured: Ellen Perocchi
Loss Location: 20 Conant Street
Date of Loss: 1/27/18
Policy Number: 1424195
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 Chapter 139, Section 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.
ADJUSTERS
TITLE:
On this date, I caused copies of this notice to be sent to the persons named
above at the addresses indicated above by first class mail.
Fred M. Newell,
Adjuster
DATE: 1/29/18