13 Olde Village Dr_Claim Notice_ 11.05.22 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 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.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: THOMAS STANGA, JOHN&COURTNEY GRAY
Property Address: 13 OLDE VILLAGE DR. SALEM, MA 01970
Policy Number: 1573602
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 11/05/2022
Claim Number: 468359
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
:''SOY