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65 REAR ESSEX STREET - CLAIM NOTICE THEN0RF0LK.,f-7---0DEDHAMGR0UPe Norfolk&Dedham Mutual Fire insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co. June 4, 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.: P2183881 Insured: ANASTASIOS ANDRONIKIDIS DESPINA ANDRONIKIDIS Address: 65 REAR ESSEX ST, SALEM, MA Policy No.: D1996909A Loss Date: 05/26/2021 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, Bonnie L. Purcell Sr. Property Claim Adjuster 1-800-688-1825 x1708 Home Office Mid-Atlantic 222 Ames Street,P.O.Box 9109 hD 50 Division Street,suite 400 Dedham,MA 02027-9109 SINCE 1825 Somerville,NJ 08876 Phone:(800)688.1825 www.ndgroup.com