8 ECLIPSE LN MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Me Only(800)392.6108.FAX(8001851.8424
5/27/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
SALEM BUILDING COMMISSIONER
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 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