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35 Ravenna Avenue- Claim Notice 0636 ■"st at e.DALLA,OTX665266 You're in good hands. 1�19J11111'1'111111111111151111,11111'll�l�l�l"�91111d�� SALEM CITY HALL 93 WASHIRGTON ST STE 1 SALEM MA 019703530 April 21.2022 INSURED: BARRY LENTNEK PHONE NUMBER: 800-729-6400 DATE OF LOSS: April 08,2022 FAX NUMBER: 866-447-4293 CLAIM NUMBER: 0665437497 HRB OFFICE HOURS: Mon - Fri 8:00 am - 530 pm, PROPERTY ADDRESS: 35 RAVENNA AVE. SALEM,MA Sat 8:00 am -4:00 pm POLICY NO.: 000984340153 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws.Ch, 139.Sce.3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen CITY/TOWN HALL: SALEM CITY HALL ADDRESS: 93 WASHINGTON ST CITY/TOWN/ZIPCODE: SALEM. MA 01970 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 attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss and claim number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. SIGNATURE AND DATE RONALD BADCHKAM April 21,2022 Copy : BARRY LENTNEK Apt PROP054 3000020220421 TR001000235001001000332