1A DANIELS ST CT_ CLAIM NOTICE 4.29.23 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Ma Only(800)392-6108, FAX(800)851.8424
5/6/2023
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: HANS WEEDON
Property Address: 1A DANIELS ST CT. SALEM. MA 01970
Policy Number: 1280553
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/29/2023
Claim Number: 472492
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