20 Carriage Hill Lane 3-17-19 claim RECEIVE® LaMarche Associates
5 North Road, P.O. Box 250
MAR 2 5 2019 Chelmsford, MA 01824
CITY OF SALEM 800-349-1525
BOARD OF HEALTH Fax: 978-256-8590
March 18, 2019
Building Commissioner/Inspector of Buildings
Salem, MA 01970-1700
Board of Health/Board of Selectmen
Salem, MA 01970-1700
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: Lisa Cousin
Loss Location: 20 Carriage Hill Lane
Salem, MA 01970-1700
Policy Number: H017060142
Date of Loss: 03/17/2019
Cause of Loss: Water
LA File Number: MA-2-36261
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.-800-349-1525
Page 1 of 1