13 OLDE VILLAGE DRIVE 8-20-23 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
8/26/2023
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen. Laws, Ch.139. Sec.313
AUG 31 2023
CITY OF SALEM
SALEM HEALTH DEPT. BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: COURTNEY GRAY&JOHN GRAY AND
Property Address: 13 OLDE VILLAGE DR, SALEM, MA 01970
Policy Number: 1614566
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 08/20/2023
Claim Number: 474638
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 313 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