16 OAKLAND STREET 11-25-24 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
11/30/2024
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws.Ch.139, Sec.36
RECEIVED
SALEM HEALTH DEPT
SALEM CITY HALL DEC 0 5 2024
SALEM MA 01970
CITY OF SALEM
BOARD OF HEALTH
Re: Insured: LUCIEN REYNOSO AND WILLY REYNOSO
Property Address: 16 OAKLAND ST, SALEM, MA 01970
Policy Number: 1630301
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 11/25/2024
Claim Number: 482705
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