10 Gifford Court 10-5-20 claimLaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
October 19, 2020
Building Commissioner/Inspector of Buildings
Salem, MA 01970-2211
Board of Health/Board of Selectmen
Salem, MA 01970-2211
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:Maureen Jacoby
Loss Location:10 Gifford Court Unit 1
Salem, MA 01970-2211
Policy Number:H012155762
Date of Loss:10/05/2020
Cause of Loss:Water
LA File Number:MA-2-38639
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.
Connor Dooley
Adjuster
LaMarche Associates, Inc. - 800-349-1525Page 1 of 1