462 Lafayette Street 10-17-19 claim LaMarche Associates
5 North Road, P.O. Box 250
RECEIVED Chelmsford, MA 01824
800-349-1525
OCT 212019 Fax: 978-256-8590
CITY OF SALEM October 17, 2019
BOARD OF HEALTH
Building Commissioner/Inspector of Buildings
Salem, MA 01970-5341
Board of Health/Board of Selectmen
Salem, MA 01970-5341
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: Nicholas Mosher
Loss Location: 462 Lafayette Street
Salem, MA 01970-5341
Policy Number: 2003488370
Date of Loss: 10/17/2019
Cause of Loss: Wind
LA Mile Number: MA-2-37108
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
Page 1 of 1