10 Mall Street 3-9-20 claim RECEIVED
Butterwort O'7ool,-e, Inc. MAR 16 2020
ADJUSTERS/APPRAISERS CITY OF SALEM
FOR INSURANCE COMPANIES ONLY BOARD OF HEALTH
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
c laim sCl butterworthoto o le.corn
03/12/2020
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: Anthony Karamas
Address: 10 Mall Street
Salem, MA 01970
Policy No.: 2546520
Loss of: 03/09/2020 Water
File or Claim No.: 05-0188
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
Si.NJ�
Member of
National Association of Independent Insurance Adjusters