17 Beaver St_ Claim Notice 8.12.22 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)7233800 Ma Oniv(800)392.6108. FAX(800)851.8424
8/20/2022
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: PATRICK CHEEVER
Property Address: 17 BEAVER ST, SALEM. MA 01970
Policy Number: 1588876
Type Loss: Vehicle Damage
Date of Loss: 08/12/2022
Claim Number: 466994
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
F itty v.. . 411 :4
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