14 Cousins St_Claim Notice 10.17.22 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723-3800 Ma Only(800)392.6108. FAX(800)851.8424
11/12/2022
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: MICHELLE ARPIN
Property Address: 14 COUSINS ST, SALEM, MA 01970
Policy Number: 1432482
Type Loss: All Other Section I Losses
Date of Loss: 10/17/2022
Claim Number: 468426
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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