52-54 DUNLAP STREET - CLAIM NOTICE Phone: 978-632-2660 Fax: 978-632-2662
JAMES A. TRUDEAU
Adjustment Service Inc.
P. O.Box 7
Gardner,MA 01440
claim s0atrude1u1d'.com _
Notice of Casualty Loss of Building
Under Massachusetts General Laws, Chapter 139, Section 313
November 2,2021
Building Inspector
93 Washington Street
Salem,MA 01970
Board of Health
93 Washington Street
Salem,MA 01970
Fire Department
Dept. of Records
48 Lafayette Street
Salem,MA 01970
Insured: William Riley
Loss Location: 52-54 Dunlap Street,Salem,MA 01970
Insurance Company: The Concord Group Ins.Companies
Policy No.: 1039508
Date of Loss: October 26,2021
File Number: 21-19520
Claim Number: 30028284
Type of Loss: Tree
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, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the
captioned insured, location,policy number, date of loss, and file or claim number.
Claim has been made involving loss, damage or destruction of the above-captioned property, which may
exceed $5000. If any notice under Massachusetts General Laws, Chanter 175, Section 97A is appropriate,
please direct it to the attention of this writer and include a reference to the above-captioned insured,
location,policy number,date of loss and claim number.
On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first
class mail.
Sincerely,
Justen Hires tint)g PM '''
Claims Adjuster NOV