490 Loring Avenue 7-15-18 claim J RECEIVED
JUL 2 3 2013
Butterworth & O'?ooLe, Inc.
CITY OF SALEM
ADJUSTERS/APPRAISERS BOARD OF HEALTH
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
c I aimsAbutterworthotoole.com
07/16/2018
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: Steven Decoste
Address: 490 Loring Avenue
Salem MA 01970
Policy No.: 2378285
i
Loss of: 07/15/2018 Wind
File or Claim No.: 87-1193
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 any type against this property and we will recommend to the insuring company
that this claim is paid.
Patrick Davis
Adjuster
t
^Mernfier o/
National Association of Independent Insurance Adjusters