22 Hanson Street 3-2-18 claim RECEIVED
MAR 12 2018
JCS CITY OF SALEM
,- BOARD OF HEALTH
Butterworth & O'TOOfe, In"
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
claims@butterworthOtOOle.COm
03/05/2018
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN.LAWS, CH- 139, SEC. 3B
TO: Fire & Health Inspector
Building Inspector & l Department 120 Washington Street 4th
City Hall 48 Layfayette Street floor
Salem, MA 01970
Salem, MA 01970
Salem, MA 01970
RE: Insured: David Shea
Address: 22 Hanson—
Salem MA 01970
Policy No.: 2056937
Loss of:
03/02120IS Wind
File or Claim No.: 87-0448
Claim has been made involving loss, tioned property,which may either exceed
damage or destruction of the above cap
e applicable. if any notice
.Laws
Ch0039.Secc3B is appropriane,please direct
it t 4 he attention of the waiter and include a reference under to the captioned
insured, location,policy number,date of loss and claim or file number. e no liens of any type against this
If no reply is received from your office within ten days,we will assume yu hav
that this claim os paid
property and we will recommend to the insuring company
Patrick Davis
Adjuster
�``Ully;ly
Member of
National Association of Independent Insumnce Adjusters