116 FEDERAL STREET 12-28-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
12/31/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139. Sec.313
SALEM HEALTH DEPT
SALEM CITY HALL
SALEM MA 01970
Re: Insured: HEATHER KARJANE
Property Address: 116 FEDERAL ST APT 1,SALEM, MA 01970
Policy Number 1528445
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 12/28/2022
Claim Number: 469284
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.;,Char ter 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. REE C E i V E
MPIUA Claims Division JAN 0 9 20a
CITY OF SALEM
BOARD Or HEr+-TH
CMA00021