162 NORTH ST- CLAIM NOTICE 6.3.24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Me Only(800)392.6108,FAX(800)851.8424
6/8/2024
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: MARY ELLEN MANNING
Property Address: 162 NORTH ST. SALEM. MA 01970
Policy Number: 1136301
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 06/03/2024
Claim Number: 480173
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
"124 JILIN 12