258 LAFAYETTE STREETN #4 - CLAIM NOTICE 1100 Crown Colony Drive
P.O.Box 699195
AA � � �,.,� � � �� Quincy,MA 02269-9952
11 617.328.2800
INSURA14CE GROUP arbella.com
November 11, 2021
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
93 WASHINGTON STREET
SALEM, MA 01970
Claim Number: 034225232
Company Name: Arbella Mutual Insurance Company
Date of Loss: 11/02/2021
Insured: ELIZABETH KEEGAN
Property Location: 258 LAFAYETTE ST 44, SALEM,MA
To Whom It May Concern:
A claim has been made involving loss, damage, or destruction of the above captioned property, which
may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,to be
applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate,please direct it
to the attention of the writer. Please include a reference to the captioned insured,location, date of loss
and claim number.
Thank you for your assistance.
Best regards,
Cynthia Holden-Amor
Claim Service Specialist
Property Claim Office
800-272-3552 ext.7549
Fax 617-773-4760
NOV �5 F'ml:3-3
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