39 BALCOMB STREET - CLAIM NOTICE THEN0 �F0L1t.f-7---'Q`_.OHAMGROUPe
Norfolk& Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
August 20, 2021
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
Board of Health or Board of Selectmen
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
Fire Department or Arson Squad
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
RE: Our File No.: P2186957
Insured: MARK ZOLLA
CHRISTINA ZOLLA
Address: 39 BALCOMB STREET, SALEM, MA
Policy No.: H1412499A
Loss Date: 08/19/2021
Loss Type: Building or Other Structure Damage
A 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, Ch. 143, Sec. 6 to be
applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct
it to my attention and include a reference to the captioned insured, location, policy number, loss
date 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 the claim will be paid in our customary manner.
Sincerely,
I t 23
AUG
Joy Pollock
Sr. Property Claims Examiner
1-800-688-1825 x1289
Home office Mid-Atlantic
222 Ames Street,P.O.Box 9109 g 50 Division Street,Suite 400
Dedham,MA 02027-9109 SINCE 1825 Somerville,NJ 08876
Phone:(800)688.1825 www.ndgroup.com