72 Washington Sq East_ 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
1/7/2023
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: NANCY L SACHETTI TRUSTEE, NANCY
Property Address: 72 WASHINGTON SQ. EAST, SALEM, MA 01970
Policy Number: 1413832
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 12/18/2022
Claim Number: 469395
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