32 CLARK STREET 8-4-19 CLAIM RFGEJvED
16�01g LaMarche Associates
AEG 5 North Road, P.O. Box 250
Chelmsford, MA 01824
BOARD OF HEALTH 800-349-1525
Fax: 978-256-8590
August 6, 2019
Building Commissioner/Inspector of Buildings
Salem, MA 01970
Board of Health/Board of Selectmen
Salem, MA 01970
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: Janet Forman
Loss Location: 32 Clark Street
Salem, MA 01970
Policy Number: H5226520
Date of Loss: 08/04/2019
Cause of Loss: Water
LA File Number: MA-2-36861
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.
David Valley
Adjuster
LaMarche Associates,Inc.-800-349-1525
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