18 NORTHEND AVENUE - BUILDING INSPECTION 18 NORTH W AVENUE
i
BAY STATE ADJUSTMENT SERVICE
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_ ,n�nl�ieuun P.O. BOX 338 '-fAP
ANDOVER, MASSACHUSETTS 01810-0338 AiiaWr '
WSS106111{ ,u K.M.l
FAX # 508-474-0336 ouili`i
Andover: 475-8111 Lowell: 458-2542
Haverhill: 374-9282 Lynn: 5985050
I/CITY FIRE DEPARTMENT
QLDING COMMISSI0IER or BOARD OF HEALTH or
NSPECTOR OF BUILDINGS OARD OF SELECTMEN
CITY OF SALEM ) CITY OF SALEM
CITY HALL ) CITY HALL
SALEM, MA 01970 ) SALEM, MA 01970
RE: INSURED: SAMUEL S SPATAFORE
PROPERTY ADDRESS: 18 NORTHEND AVENUE SALEM MA
POLICY NO.: ZD078081 COMPANY: ARBELLA MUTUAL
LOSS OF: WINDSTORM DATE: DECEMBER 12 , 1992
FILE OR CLAIM NO. : 2-1527—X
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 a
captioned insured, location, policy number, date of loss and claim or file
number.
WILLIAM J MCGETTRICK JR. , ADJUSTER
Title
On this date, I caused copies of this notice to be sent to the persons named
above, at the addresses indicated above, by ffirssttQ class mail.
N 5_Q n 1/11/93
Signature f�` Date
44-902
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