7 NORTH PINE STREET - CLAIM NOTICE 4ML
Claims Department 75 Sam Fonzo Drive I Beverly,Massachusetts 01915
800.227.2757 1 Electriclnsurance.com
December 8, 2021
Building Commissioner or
Inspector of Buildings
98 Washington St
Salem, MA 01970
RE: Insured: STEPHANIE ELLIS
Claim Number: 20211208A21
Policy Number: H6483668H1
Date of Loss: October 08, 2021
Property Address: 7 N PINE ST SALEM, MA 01970-3218
Form of Notice of Casualty Loss to Building
Under Massachusetts General Laws Chapter 139, Sec. 3B
Claim has been made involving loss, damage or destruction to the above-captioned property, which may
equal or 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 to
the attention of the undersigned and include a reference to the captioned insured, location, policy
number, date of loss and claim or file number.
On December 8, 2021 copies of this notice were sent by first class mail to the entities and addresses
noted herein.
Sincerely,
Flw4di 60aad
Brendan Collins
Claims Specialist
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DEC
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