289 ESSEX STREET Apt 213_ Claim_ 8-2-24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Ma Only(800)392.6108,FAX(800)851.8424
9/21/2024
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: TIM LEAVITT
Property Address: 289 ESSEX ST APT 213. SALEM. MA 01970
Policy Number: 1516496
Type Loss: Other Physical Damage
Date of Loss: 08/02/2024
Claim Number: 481795
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