Notice of Loss 61423 THENORFOLK yDEDHAMGROUP®
Norfolk&Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
June 16, 2023
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings
do City or Town Hall
1146 Route 28 RECEIVED
South Yarmouth, MA 02664 - - "
JUN 20 2023
Board of Health or Board of Selectmen
do City or Town Hall BUILDING DEPARTMENT
1146 Route 28 w-
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.: P2313485
Insured: ANGELIKA P PFEIFER
Address: 55 W GREAT WESTERN RD, SOUTH YARMOUTH, MA
Policy No.: H2333711A
Loss Date: 06/14/2023
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,
h�rz
William Lamb
Manager, Property Claims
1-800-688-1825 x1137
Home Office
222 Ames Street,P.O.Box 9109 SINCE 1825
Dedham,MA 02027-9109
Phone:(800)688.1825