66 WEATHERLY DR_ 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.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: ANDREA SALDARRIAGA
Property Address: 66 WEATHERLY DR,SALEM, MA 01970
Policy Number: 1631765
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 04/22/2024
Claim Number: 479555
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