10 Buffum Street 3-1-18 claim RECEIVED LaMarche Associates
5 North Road, P,O. Box 250
JUN 0 7 2018 Chelmsford, MA 01824
800-349-1525
CITY OF SALEM Fax: 978-256-8590
BOARD OF HEALTH
May 22, 2018
Building Commissioner/Inspector of Buildings
SALEM, MA 01970-2308
Board of Health/Board of Selectmen
SALEM, MA 01970-2308
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: THOMAS & STEPHEN KAPNIS
Loss Location: 10 BUFFUM STREET
SALEM, MA 01970-2308
Policy Number: DF13038804
Date of Loss: 03/01/2018
Cause of Loss: Physical Damage
LA File Number: MA-2-35061
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.
John Anderson
Adjuster
LaMarche Associates,Inc.-800-349-1535
Page 1 of 1