Notice of Loss 3123 THENORFOLIDEDHAMGROUP®
Norfolk&Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
March 7, 2023
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings RECEIVED
do City or Town Hall
1146 Route 28
South Yarmouth, MA 02664 1AR 6 9 2023
Board of Health or Board of Selectmen BUILDING DEPARTMENT
By
c/o City or Town Hall
1146 Route 28
South Yarmouth, MA 02664
Fire Department or Arson Squad
do City or Town Hall
1146 Route 28
South Yarmouth, MA 02664
RE: Our File No.: P2309289
Insured: FREDERICK BARRY
KAREN BARRY
Address: 11 PINNACLE LANE, YARMOUTH PORT, MA
Policy No.: H2242374A
Loss Date: 03/01/2023
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,
Laurie A Fernandes
Senior Property Claims Examiner
1-800-688-1825 x1238
Home Office
222 Ames Street,P.O.Box 9109
Dedham,MA 02027-9109 SINCE 1825
Phone:(800)688.1825