162 NORTH STREET_ WATER DAMAGE CLAIM 7-7-24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Me Oniv(800)392.6108.FAX(800)851-8424
7/27/2024
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: MARY ELLEN MANNING
Property Address: 162 NORTH ST. SALEM, MA 01970
Policy Number: 1136301
Type Loss: Water Damage:Appliance failure
Date of Loss: 07/07/2024
Claim Number: 481005
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 38 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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