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374 Essex Street 8-20-18 claim RECEIVED LaMarche Associates OCT 15 2018 5 North Road, P.O. Box 250 Chelmsford, MA 01824 CITY OF SALEM 800-349-1525 BOARD OF HEALTH Fax: 978-256-8590 October 9, 2018 Building Commissioner/Inspector of Buildings Salem, MA 01970-3255 Board of Health/Board of Selectmen Salem, MA 01970-3255 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: Emma Hamilton &James Sullivan Loss Location: 374 Essex Street Salem, MA 01970-3255 Policy Number: H012367194 Date of Loss: 08/20/2018 Cause of Loss: Water LA File Number: MA-2-35578 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. Kevin Gabbett Adjuster LaMarche Associates,Inc.-800-349-1525 Page 1 of 1