1A DANIELS STREET COURT 4-29-23 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
5/6/2023
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws Ch.139 Sec.313
RECEIVE®
SALEM HEALTH DEPT. MAY 112023
SALEM CITY HALL
SALEM MA 01970 CITY OF SALEM
BOARD OF HEALTH
Re: Insured: HANS WEEDON
Property Address: 1A DANIELS ST CT. SALEM, MA 01970
Policy Number: 1280553
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/29/2023
Claim Number: 472492
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