13 OLDE VILLAGE DRIVE 12-16-24 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
3/8/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139. Sec.313 RECEIVE[
MAR 14 Z025
SALEM HEALTH DEPT CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
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