0009 1/2 BARR STREET - BUILDING JACKET UPC 10333
No. 153L-3
HASTINGS.UN
BUTTERWORTH & 0700LE, INC. /71
P.O. BOX 8294 ��/
SALEM, MA 01971-8294 y�J
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY v /
TELEPHONE (978)741-5731 - FAX (978)740-9109
November 22, 2000
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS . GEN. LAWS, CH. 139, SEC . 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
Salem, MA 01970 Salem, MA 01970
RE: Insured: David Harrington ��a
Address : 9 1/2 Barr Street CGC���A1T
Salem, MA 01970 �s/ ¢-T
Policy No. : FP1770190 C 60�f aJT
Loss of: 11/21/00
File or Claim No . : 06-1726
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, Ch. 139, Sec. 3B is appropriate, please direct it
to the attention of the writer and include a reference to the captioned
insured, location, policy number, date of loss 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 we will
recommend to the insuring company that this claim is paid.
Robert L. Smith, Jr.
Adjuster
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