8 ECLIPSE LANE 5-23-23 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(6171723-3800 Ma Only(800)392-6108, FAX(800)851-8424
5/27/2023
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: MARINA KOGAN AND ALEKSANDR KHESIN
Property Address: 8 ECLIPSE LN,SALEM, MA 01970
Policy Number: 1537254
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 05/23/2023
Claim Number: 472856
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. Chacter 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
RECEIVED
JUN 0 6 Z023
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