15 FOREST AVENUE - BUILDING INSPECTION 15 FORRSm AVENUE
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BAY STATE ADJUSTMENT SERVICE
100 Cummings Center, P.O. Box 7022, Beverly, MA 01915
Telephone Numbers
(978)927-9929
(800)865-2206
24 Hour Emergency Number(978)977 2684
FAX(978)927-8118
City Fire Department
Inspector of Buildings Board of Health
City of Salem City of Salem
City Hall City Hall
Salem, MA 01970 Salem, MA 01970
Re: Insured: Elizabeth G. Legasey Company: Patrons Mutual Fire Insurance Co.
Property 15 Forest Avenue Date of 01/16/00
Address: Loss:
Salem, MA 01970
Policy No.: HMA2035705 _
File No.: 0019W
Claim has been made involving loss, damage or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Massachusetts General Law,
Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Law,
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 file
number. This is not a request for a report this is to comply with Mass notification laws as
set forth above.
Paul R. Nestor, Jr.
General Adjuster
On this date, I caused copies of this notice to be sent to the persons named above, at the
addresses indicated by first class mail.
pl'W-A 1/18/00
Si nature Date
Association of National Association
Independentlnsurance of Independent
Adjusters of Insurance Adjusters
Massachusetts Member
Member
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