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24A-030 (14)
f 1) -1F' T GEC ) 91 DEC 0 I 1 LAMARCHE ASSOCIATES, INC. p_n_ Rnx RL�n ©EPiOE$UIL[)!NG INSPECTIONS PALMER, MA 01069 MOI T',"; 'ii d Y\'4 01060 Date 12-1-92 Building Commissioner/Inspector of Buildings TOWN OF NORTHAMPTON aLi 0 -- 03o URA Board of Health/Board of Selectmen TOWN OF NORTHAMPTON NOTICE OF CASUALTY LOSS TO BUILDING inc.-4. 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 6to 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 cap- tioned insured, location, policy number,date of loss, and LA file number. Insured: GONSKI, WTLT,TAM & ALTCF Property Address: 78 RIDGEWOOD TERRACE NORTHAMPTON, MA 01060 Policy No. H0891787 Loss of 8-31-92 _ 19 LA File No. 09336 41 di,ka (Signature) ) Title: ADJUSTER 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. L'4)k- A2 Signature and date (11/ 12-1-92