18 PRESCOTT STREET NOTICE OF CASUALTY LOSS -��������� N ��N��� p�
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Norfolk&Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
October 28. 2021
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139. SEC. 3KB
Building Commissioner, or Inspector ofBuildings
c/o City or Town Hall
93 Washington St.
So|ann, MA 01970
Board of Health or Board of Selectmen
c/o City or Town Hall
83 Washington GL
8o|enn, MA 01970
Fire Department or Arson Squad
c/o City or Town Ho||
93 Washington 8t.
Sa|enn, MA 01970
RE: Our File No.: P2189734
Insured: G|C)VANN| OELLAK4C>N|CA
Address: 10 PF{EGCOTT GTREET, 8ALEM, MA
Policy No: O520892
Loss Date: 10/27/2021
Loss Type: Building or Other Structure Damage
A o|oinn has been made involving |oaa. damage or destruction of the above captioned property,
which may either exceed $1.000.00 or cause K8oee. Gen. Lavva, Ch. 143, Geo. G to be
applicable. If any notice under Mass. Gen. Lovva. Ch. 139. Sec. 3B is 8ppropriate, please direct
it to my attention and include a reference to the captioned insured, /ocoUon, policy number, |Voa
data and claim or file number.
If no reply is received from your office within tan doya, we will assume you have no liens of any
type against this property, and the o|ainn will be paid in our customary manner.
8inoeny|y.
�0.V 1PN-31:3 6
NIOU
Joy Pollock
Sr. Property Claims Examiner
1-800-888-1825 x1289
Home Office Mid-Atlantic
222 Ames Street,P.O.Box g1Oe AD, sn Division Street,.Suite*nn
Dedham,MA 02027'9109 S|NCE1O25 Somerville',NJ 08876
Phone:(88n)so@.1n25 w*w.nuQmup.umm