29-045 (5) "MULTILINE ADJUSTERS SVM4LlZINa IN UUAMY"
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M " OCT 2 0
E C SPECIAL INVESTIGATION '
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A.S.AT. hhonst (411) 567.4151 I;
Still" 3 I`AX� (411) 567-7991 3S
24 Ehn Shopnl
Wa5111eld. MA 01095
TO! nullding Inspector Uoard of Health
Town of Florence
(addresses) City Hall
ITS: Insured., Ellerbrook, Ray & Wendy _
Property Address : 23 Pioneer Knolls _
__ Florence, MA 01060 --
I,oI icy 110: H09260131
Doss or :
Pile or Claim No: _ 93P-13659
claim has been made .involving loss, damage or d- trucL- on or the at,ove-
r111t't:f oned property, which may either exceed $1 , 000. 00 or cause Mass .
Gen. Laws Chapter 143 , Section 6 to be applicable. If any nonce
1�W er. Mass . Gen. Laws, Chapter 139 Section 3B is appropriate please
T_To taattention o ae lw i e
include a reference to I h-
captioned .insured, location, policy number, date of loss and lai or
file number.
JSI nature)
011 this date, 1 caused copies of this notice to be sent Lo the E�e1_s�nar
named above at the addresses indicated above by first class mail .
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Signature an Date
"MMILINE ADJUSTEFIS SPECIALIZIN(I IN OUALIIY"
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Sulle 3 rAX! 1413I 567-799:1
?4 Elm Slr�ol •
We41110d, Mn OIOBS
'ro! SUI lding Inspector Board or health
Town of Florence
Florence MA 01060 (addresses) ------
11r:.: Insured: Ellerbrook, Wendy & Ray
Property Address : _ 23 Pioneer Knolls
Florence MA 01060 _------
Policy No: x09260131
i_,oss or : 10/9/93 --.-
t'il e or Claim No: _ 93P-13659
claim has been made involving loss, damage or destruction or the above-
(711pti.oned property, which may either exceed $1_, 000 . 00 or call-Se Mass .
Gen. Laws , Cha ter 14J Section G to be applicable. 1f any notice
i111 P-r t9ass . Gen. Laws
Chapter 139 Section 3[i is appropriate please
direct: i� �a-� iTe aE en lon��the -- ter and include a rererence to 1:111-
captioned insured, location, policy number, date or loss and claim or
rile number_ . j
jSignatutre)
vn t:his date, I caused copies or this notice to be sent to the perrona�
11:1►nf-d ahovn at the addresses indicated above by r i r.st class ma i-1 .
S Ig na CU re an —Da te