9 CLOUTMAN STREET 11-17-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108,FAX(8001851-8424
11/19/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139,Sec.313 RECEIVED
NOV 2'8 2022
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: MICHAEL WAND KATHLEEN M SICOTTE
Property Address: 9 CLOUTMAN STREET,SALEM, MA 01970
Policy Number: 1187759
Type Loss: Vehicle Damage
Date of Loss: 11/17/2022
Claim Number: 468513
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed$1000.00 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
and claim or file number.
MPIUA Claims Division
CMA00021