361 ESSEX ST_ CLAIM NOTICE 4.30.23 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723.3800 Me Only(8001392-6108, 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: DARCY BIRSE
Property Address: 361 ESSEX ST, SALEM. MA 01970
Policy Number: 1565791
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 04/30/2023
Claim Number: 472462
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