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2 Larkin Lane 10-16-19 claim RECEIVED LaMarche Associates DEC 0 9 2019 5 North Road, P.O. Box 250 CITY OF SALEM Chelmsford, MA 01824 800-349-1525 BOARD OF HEALTH Fax: 978-256-8590 December 3, 2019 Building Commissioner/Inspector of Buildings Salem, MA 01970-5624 Board of Health/Board of Selectmen Salem, MA 01970-5624 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, Charter 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: Lorenzo & Christine Hill Loss Location: 2 Larkin Lane Salem, MA 01970-5624 Policy Number: HO12076895 Date of Loss: 10/16/2019 Cause of Loss: Tier 2 LA File Number: MA-2-37353 . 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. Brian Aspell Adjuster LaMarche Associates,Inc.-800-349-1525 Page 1 of 1