17 GREENWAY ROAD - CLAIM LOSS NJ 1P
Butterworth & O'r'oofe, Inc.
ADJUSTERS14PPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX(978)740-9109
claimsnbutterworthotoole.com
07/09/2021
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 Street 4th
floor
Salem,MA 01970 Salem,MA 01970 Salem,MA 01970
RE:Insured: Linda Mein
Address: 17 Greenway Road
Salem, MA 01970
Policy No.: 3087742
Loss of: 07/09/2021 Water/Seepgge
File or Claim No.: 15-0597
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,Chaster 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 Fole•
Adjuster
Member of JUL 12 PM33 a 25
National Association of Independent Insurance Adjusters JUL