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29-265 (4) GEORGE A. BUTLER ADJUSTERS, INC. ADJUSTERS FOR INSURANCE COMPANIES 15 Mulberry Street Springfield, Massachusetts 01105 (413) 781-2897 SPRINGFIELD, MA PITTSFIELD,MA FAX* 731-5553 WORCESTER, MA HARTFORD, CT (413) 781-2897 (413)442-6328 (508) 754-4100 (203) 525-9034 OCT 210 October 18, 1993 TO: ilding Commissioner or Board of Health or nspector of Buildings Board of Selectmen Town Hall Town Hall Florence, MA 01060 Florence, MA 01060 Attention: Records Attention : Records RE: Our File Number : 01-A2-1093-031 Name of Insured : Donald R. ( Sr . ) & Jean A. Marhefka Address : 63 Longview Drive, Florence, MA Insurance Company: Massachusetts Property Insurance Underwriting Association Policy Number : 20-2-317064-03 Date of Loss : 10/06/93 Gentlemen : Claim has been made involving loss, damage, or destruction of the above-captioned property which may either exceed $1, 000, or cause Massachusetts General Law, chapter 143, Section 6, to be applicable . I£ any notice under Massachusetts General Law, Chapter 139, Sectioti 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, and claim or file number . Peter E. Shea Adjuster On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above, by first class mail . Lisa Mazza 10/18/93 i ,et s