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50 (WWII Club) Loss to Building 2016 LaMarche Associates 1482 North Main Street, P.O. Box 840 Palmer, MA 01069 800-222-0143 Fax: 413-289-1249 January 8, 2016 Building Commissioner/Inspector of Buildings Northampton, MA 01060 Board of Health/Board of Selectmen Northampton, MA 01060 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 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, cause of loss and LA file number. Insured: World War II Veterans Club Loss Location: 50 Conz Street Northampton, MA 01060 Policy Number: CS0257128801 Date of Loss: 01/06/2016 Cause of Loss: Water LA File Number: MA-1-25392 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Bryan Thomas Adjuster La Marene Associates.Inc.- 227-010 Page 1 of 1