11 CHURCH STREET, #109 7-11-12 CLAIM LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
978-256-8586
Fax: 978-256-8590
September 5, 2012
Building Commissioner/Inspector of Buildings C/ SFP 7020
SALEM, MA 01970 e�� 1},OF 12 O
of Health/Board of Selectmen A�oFti4-
Board
SALEM, MA 01970 1,
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, which
may either exceed $1,000.00 or cause Massachusetts General Laws. Chapter 143, Section 6 to be
applicable. If any notice under Massachusetts General 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, cause of loss and LA file number.
Insured: THE ESSEX CONDOMINIUM
Loss Location: 11 CHURCH STREET, #109
SALEM, MA 01970
Policy Number: 1120M13421
Date of Loss: 7/11/2012
Cause of Loss: Water
LA File Number: MA-2-21670
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.
Kris Kirkpatrick
Adjuster
LaMarche Associates,Inc.-800-349-1525
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