84 Flint St_Claim Notice 8.24.22 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Me Only(800)392.6108,FAX(8001851.8424
9/3/2022
Form of Notice of Casualty Loss to Building
Under Mass Gen. Laws Ch.139, Sec.313
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: RAYMOND HARVEY
Property Address: 84 FLINT ST, SALEM. MA 01970
Policy Number: 1560520
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 08/24/2022
Claim Number: 467236
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
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