6 BEAVER STREET 11-13-19 CLAIM RECEIVED
JUN 2 2 2020
Dittterivorth & 0'76' lie, Inc. CITY OF SALEM
ADJUSTERS/APPRAISERS BOARD OF HEALTH
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
claimsg.butterworthotoole.com
06/16/2020
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC.3B
TO:
Building Inspector & Salem Fire Department & Health Inspector
City Hall 48 Layfayette Street 120 Washington Street 4th
floor
Salem, MA 01970 Salem, MA 01970 Salem, MA 01970
RE: Insured: Peter McSwiggin
Address: 6 Beaver Street
Salem, MA 01970
Policy No.: 2312045
Loss of: 11/13/2019 Water/Burst Pipe
File or Claim No.: 05-0449
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.
John Folev
Member of
National Association of Independent Insurance Adjusters