13 OLDE VILLAGE DR_ NOTICE OF LOSS 12-16-24 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392.6108. FAX(800)851-8424
3/8/2025
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: COURTNEY GRAY AND JOHN GRAY
Property Address: 13 OLDE VILLAGE DR. SALEM. MA 01970
Policy Number: 1688505
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 12/16/2024
Claim Number: 484240
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