19 IRVING STREET 12-22-25 CLAIM
P.O. Box 2487
Woburn, MA 01888
P: (781) 755-8554
F: (781) 757-0885
claims@benchmarkclaims.com
12/23/2025
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
City of Salem
City Hall
Building Inspector
Salem, MA 01970
City of Salem
City Hall
Health Inspector
Salem, MA 01970
Salem Fire Department
Salem, MA 01970
Insured: Edward Patch and Julie Patch
Address: 19 Irving Street, Salem, MA 01970
Policy No.: FP22685181
Date of Loss: 12/22/2025
Origin: Water
Our File No.: 25-512
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.
Sincerely,
Brad Doherty
Brad Doherty
Owner