260 Jefferson Avenue 11-7-21 claim REC 9VED
NOV 16 2021
Claim # CITY OF SALEM
Advantage Claim Services Adjuster Assigned: G Guarente BOARD OF HEALTH
200 Sutton St. Suite 233
North Andover MA 01845
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch. 139, Sec. 3B
To: HEALTH DEPARTMENT
CITY OF SALEM 3RD FLOOR
98 WASHINGTON ST
SALEM MA 01970
Re: Insured: Mirash Begi
Property address: 260 Jefferson Ave.
Salem, MA 01970
Policy #: 2595185
Loss of: 2021/11/07
File or Claim No. AD 2803
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.
G Guarente
Title: Adjuster
On this date, I caused copies of this notice to be sent to the persons
named at the addresses indicated above by first class mail.
11-10-2021
Signature and date