18 Roslyn Street 2-17-18 claim € ECEIVED LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
FEB 2 7 2013 800-349-1525
Fax: 978-256-8590
CITY OF SALEM
BOARD OF HEALTH February 20, 2018
Building Commissioner/Inspector of Buildings
SALEM, MA 01970
Board of Health/Board of Selectmen
SALEM, MA 01970
NOTICE OF CASUALTY LOSS TO BUILDING
AL LAWS CHAPTER 139 SECTION 3B
UNDER MASSACHUSETTS GENER
property captioned
Claim has been made involving loss, damage or destruction of the pro P y
below, which may either exceed $1,000.00 or cno[ce under Massachusetts)General Laws
e Massachus
Cha ter 143 Section 6 to be applicable. If any
ro riate, please direct it tol cy nutmbero of th loss,rite wecause
Cha ter 139 Section 3B is r and
app p
include a reference to the captioned insured, location, p
of loss and LA file number.
Insured: 18 ROSLYN STREET CONDO ASSOCIATION
Loss Location: 18 SALEM, MA 01970LYN ET
policy Number: FP071241
Date of Loss: 02/17/2018
Cause of Loss: Water
LA File Number: MA-2-34320
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
WMarcOe As1-6a 1 of 1 800-349-1525
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