45 Forrester Street 1-5-18 claim RECEIVED
MAY 0 3 2018
Butterworth & O',]�ooCe, Inc. BOARDF CITY OF
S HEALTH
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
04/23/2018
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC.3B
TO:
Building Inspector & Salem Fire Department & Health Inspector
City Hall 48 Layfayette Street 120 Washington Street 4th
floor
Salem, MA 01970 Salem, MA 01970 Salem, MA 01970
RE: Insured: 45 Forrester St Condominium
Address: 45 Forrester Street
Salem, MA 01970
Policy No.: 2248938
Loss of: 01/05/2018 Water
File or Claim No.: 87-0976
Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed
$1,000.00 or cause Mass. Gen. Laws,Chapter 143 Section 6 to be applicable. If any notice under Mass. Gen. Laws,
Ch. 139, Sec.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 and claim or file number.
If no reply is received from your office within ten days, we will assume you have no liens of ally typeg against this
property and we will recommend to the insuring company that this claim is paid.
I
Patrick Davis
Adjuster
To
v i
He he)of
National Association of Independent Insurance Adjusters