4 D STILLWELL DR_12.29.23_ 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
1/13/2024
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: CORINNE CALLAHAN -
Property Address: 4D STILLWELL DR, SALEM. MA 01970
Policy Number: 1638772
Type Loss: Theft
Date of Loss: 12/29/2023
Claim Number: 477494
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