116 Federal St Apt 1_ Claim notice 12.28.22 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723.3800 Ma Only(800)392.6108, FAX(800)851-8424
12/31/2022
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: HEATHER KARJANE
Property Address: 116 FEDERAL ST APT 1, SALEM. MA 01970
Policy Number: 1528445
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 12/28/2022
Claim Number: 469284
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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