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1 BEACH AVENUE 5-10-25 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424 5/17/2025 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch.139,Sec.3B RECEIVED MAY 2 2 2025 SALEM HEALTH DEPT SALEM CITY HALL CITY OF SALEM BOARD OF HEALTH SALEM MA 01970 Re: Insured: MAUREEN HENTOSH Property Address: 1 BEACH AVE., SALEM, MA 01970 Policy Number: 0999108 Type Loss: Water Damage:All Other Water Damage Date of Loss: 05/10/2025 Claim Number: 485388 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