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6 BEAVER STREET 11-18-17 CLAIM 96(-6 RECEIVED Butterworth & ©'Ioote, Inc. DEC 0 4 2017 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY CITY OF SALEM BOARD OF HEALTH P.O.BOX 8294 SALEM,MA 01971-8294 TEL. (978)741-5731 FAX (978)740-9I09 claims(a),butterworthotoole.com 11/21/2017 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: 11/18/2017 Wind File or Claim No.: 74-1152 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.313 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. Patrick Tobin Adjuster , WE Member nJ National Association of Independent Insurance Adjusters