25 SABLE ROAD_LOSS CLAIM 7.20.23 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108. FAX(8001851.8424
3/9/2024
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: GERALD AND LAURIE KINGSTON JR
Property Address: 25 SABLE ROAD, SALEM, MA 01970
Policy Number: 1166489
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 07/20/2023
Claim Number: 478570
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