4 MARION ROAD 8-13-25 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108. FAX(8001851-8424
8/30/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139,Sec.3B RECEIVED
SALEM HEALTH DEPT. SEP 04 2025
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: DONNA ANAYA
Property Address: 4 MARION ROAD, SALEM, MA 01970
Policy Number: 1231223
Type Loss: Other Causes of consequential Mold
Date of Loss: 08/13/2025
Claim Number: 487198
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 313 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