490 Loring Avenue 7-22-21 claim RECEIVED
Butterworth & O'7oote, Inc. AUG 0 2 2021
ADJUSTERS/APPRAISERS CITY OF-SALFne
FOR INSURANCE COMPANIES ONLY BOARD OF HEALTH
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
claims@butterworthotoole.com
07/27/2021
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 Lafayette Street 120 Washington St 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
Loss of: 07/22/2021 Vehicle
File or Claim No.: 15-0690
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.
John Foley
Adjuster
Member of
National Association of Independent Insurance Adjusters