6 Saint Paul Street 10-27-21 claim
P.O. Box 2487
Woburn, MA 01888
P: (781) 755-8554
F: (781) 757-0885
brad@benchmarkclaims.com
11/5/2021
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Town of Salem
Town Hall
Building Inspector
Salem, MA 01970
Town of Salem
Town Hall
Health Inspector
Salem, MA 01970
Salem Fire Department
Salem, MA 01970
Insured: Ruthy LLC
Address: 6 Saint Paul Street, Salem, MA 01970
Policy No.: 2684050
Date of Loss: 10/27/2021
Origin: Windstorm
Our File No.: 21058
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.
Sincerely,
Brad Doherty
Brad Doherty
Owner