41 BALCOMB STREET - BUILDING IACKET UPC 10330 y
N0. Y53L_
HASTINGS, UN
BAY STATE ADJUSTMENT .SERVICE
100 Cummings Center, P.O. Box 7022, Beverly, MA 01915
Telephone Numbers
24 Hour Emergency Number(978)507 8254
(978)927-9929
(800)865-2206
FAX(978)927-8118
City Fire Department
Inspector of Buildings Board of Health
City of Salem City of Salem
Salem, MA 01970 Salem, MA 01970
Re: Margaret L. Busteed Company: Merrimack Mutual
Fire Insurance Company
Property 41 Balcomb Street Date of Loss: 05/02/00
Address:
Salem, MA 01970
Policy Number: HP1351533
File Number:, 0291
Claim has been made involving loss, damage, or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Massachusetts General Law,
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 and include a reference to the captoned insured, location, policy number, date of
loss, and file number. This is not a request for a report, this is to comply with
Masschusetts notification laws as set forth above.
Paul R. Nestor, Jr.
Adjuster
On this date, I caused copied of this notice to be sent to the persons named above, at
the addresses indicated by first class mail.
ade
/ � j `� v J May 2, 2000
Signature Date
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