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INS LOSS LTR, U4, 2015 BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY NEWTON OFFICE SALEM OFFICE P.O.BOX 238, NEWTONVILLE,MA 02160 P.O.BOX 8294,SALEM,MA 01971-8294 TELEPHONE (617) 969-6370 TELEPHONE (508) 741-5731 FAX (617) 969-3135 FAX (508) 740-9109 November 10, 1995 FORK 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 Selectmen City Hall City Hall ADDRESSES Salem, MA 01970 Salem, MA 01970 RE: Insured: Matthew Fionda Address: 5 School Street, Unit 4 Salem, MA 01970 Policy No. :D527130 Loss of: 11/7/95 File or Claim No. : 56-0349 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. Robert L. Smith, Jr. Adjuster