20 GALLOWS HILL RD_ LOSS CLAIM 4.22.24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108.FAX(800)851.8424
4/27/2024
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139,Sec.36
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: LORI WEJBE
Property Address: 20 GALLOWS HILL RD, SALEM, MA 01970
Policy Number: 1623202
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 04/22/2024
Claim Number: 479568
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