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551 insurance Loss 2021LaMarche Associates 1482 North Main Street, P.O. Box 840 Palmer, MA 01069 800-222-0143 Fax: 413-289-1249 February 9, 2021 Building Commissioner/Inspector of Buildings Florence, MA 01062 Board of Health/Board of Selectmen Florence, MA 01062 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 36 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: Patricia Coon Loss Location: 551 Burts Pit Road Florence, MA 01062 Policy Number: HP996191 Date of Loss: 02/06/2021 Cause of Loss: Vehicle LA File Number: MA -1-28378 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. Ian Young Adjuster LaMarche Associates, Inc. - 800-222-0143 Page 10(1