162 NORTH ST- CLAIM NOTICE 5.7.24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108.FAX(800)851-8424
5/11/2024
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: MARY ELLEN MANNING
Property Address: 162 NORTH ST, SALEM. MA 01970
Policy Number: 1136301
Type Loss: Water Damage:Appliance failure
Date of Loss: 05/07/2024
Claim Number: 479781
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
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