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15 Lynde Street, Unit 1 4-14-20 claim RECEIVED LaMarche Associates 5 North Road, P.O. Box 250 APR 2 8 2020 Chelmsford, MA 01824 800-349-1525 CITY OF SALEM Fax: 978-256-8590 BOARD OF HEALTH April 22, 2020 Building Commissioner/Inspector of Buildings Salem, MA 01970-3423 Board of Health/Board of Selectmen Salem, MA 01970-3423 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: Nikollaq & Ergjente Mino Loss Location: 15 Lynde Street, Unit 1 Salem, MA 01970-3423 Policy Number: HO12422510 Date of Loss: 04/14/2020 Cause of Loss: Water LA File Number: MA-2-37859 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. Kevin Gabbett Adjuster LaMarche Associates,Inc.-800-349-1525 Page 1 of 1