13 HAZEL STREET - NOTICE CLAIM ® The Commerce Insurance Company'*
MAPFRE Citation Insurance Companysm
11 Gore Road,Webster,Massachusetts 01570
INSURANCE" 508.949.1500 jwww.mapfreinsurance.com
July 02, 2021
BUILDING COMMISSIONER or Board of Health or
INSPECTOR OF BUILDINGS Board of Selectmen
TOWN/CITY HALL Town/City Hall
SALEM MA 01970
RE: Our Insured: MARMYN M HURLEY
Property Address: 13 HAZEL STREET
Policy#: BDKBGR
Date of Loss: 07/01/2021
Filet VACH82-RYYMJ3
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
NATHALIE KETNOUVONG-UNG Telephone: (508)949-1500 Ext: 15166
CLAIM REP, CAT RESPONSE Toll Free: 1-800-221-1605, Ext: 15166
On this date, I cause copies of this notice to be sent to the persons indicated above, at the
address above, by first class mail.
July 02, 2021
JUL
CIC 254 (Rev.4/95) MAIL M29