41 BARSTOW STREET 1-2-18 CLAIM RLCEIVED 5 North O. Boxa250
Chelmsford, MA 01824
JUN 1 8 201$ 800-349-1525
Fax: 978-256-8590
CITY OF SALEM
BOARD OF HEALTH June 12, 2018
Building Commissioner/Inspector of Buildings
Salem, MA 01970-2303
Board of Health/Board of Selectmen
Salem, MA 01970-2303
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: Brian Hurley
Loss Location: 41 Barstow Street
Salem, MA 01970-2303
Policy Number: 2004812200
Date of Loss: 01/02/2018
Cause of Loss: Water
LA File Number: MA-2-35122
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.
Kris Kirkpatrick
Adjuster
t Mamhe Associates,Inc.-800-349-1525
Va9e I&1