162 NORTH ST_ 7.20.22_ CLAIM NOTICE MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723.3800 Ma Only(800)392-6108, FAX(800)851.8424
7/30/2022
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: MARY ELLEN MANNING
Property Address: 162 NORTH ST, SALEM. MA 01970
Policy Number: 1136301
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 07/20/2022
Claim Number: 466640
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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