361 ESSEX STREET 4-30-23 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Oniv(8001392-6108, FAX(800)851-8424
5/6/2023
Form of Notice of Casualty Loss to Building �+
Under Mass. Gen. Laws Ch.139 Sec.36 RECEIVE®
MAY 112023
SALEM HEALTH DEPT.
SALEM CITY HALL CITY OF SALEM
BOARD OF HEALTH
SALEM MA 01970
Re: Insured: DARCY BIRSE
Property Address: 361 ESSEX ST,SALEM, MA 01970
Policy Number: 1565791
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 04/30/2023
Claim Number: 472462
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. Chater 143. section 6 to be applicable. If any
notice under Massachusetts General Laws Chap-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.
MPIUA Claims Division
CMA00021