17 Insurance Loss LaMarche Associates
1482 North Main Street, P.O. Box 840
Palmer, MA 01069
800-222-0143
Fax: 413-289-1249
January 4, 2019
Building Commissioner/Inspector of Buildings
Williamsburg, MA 01096
Board of Health/Board of Selectmen
Williamsburg, MA 01096
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: Poverty Mountain LLP
Loss Location: 17 Chesterfield Road
Williamsburg, MA 01096
Policy Number: B0205642
Date of Loss: 12/28/2018
Cause of Loss: Vehicle
LA File Number: MA-1-26963
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.
Jeffrey Davenport
Adjuster