Insurance Claim CAPE & ISLAND`.;
Adjustment, Inc
NOTICE OF CASUALTY LOSS TO A BULDING
Under MA Gen. Laws, Ch. 139, Sec. 3B
TO: INSPECTOR OF BUILDING
YARMOUTH, MA 02664
Company: The Massachusetts Property Insurance
Insured: ZEYNEP&WELLINGTON WARREN HOLMES
Property Address: 19 OLD CEDAR LANE,YARMOUTH, MA 02664
Policy Number: 0991629
File Number: 168
Claim Number: 444482
As representative of the above captioned Insurance Company, we hereby notify you, in behalf of said
Insurance Company, that claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1,000.00 or cause MA. Gen Laws, Chapter 143, Section
6 to be applicable. If, any notice under MA Gen Laws, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer and include reference to the captioned Insured, location, policy
number, date of loss and file or claim number.
Adjuster: Chris Gilman
On this date I caused copies of this notice to be sent to the persons named at the address indicated
above by first class mail.
DATE: 12/13/2019
Cape&Islands Adjustment,Inc. I P.O.Box 156 East Sandwich,MA 02537 1508-927-2058 I Jason@capeadjustment.com