161 FEDERAL STREET 8-25-23 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
9/2/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139 Sec.313 RECEIVED
SALEM HEALTH DEPT SEP 14 2023
SALEM CITY HALL CITY OFSALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: JENNIE COREY
Property Address: 161 FEDERAL ST.SALEM. MA 01970
Policy Number- 1623449
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 08/25/2023
Claim Number: 474721
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