20 GALLOWS HILL ROAD 4-22-24 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
4/27/2024
Form of Notice of Casualty Loss to Building
Under Mass, Gen. Laws,Ch.139,Sec.313
RECEIVED
SALEM HEALTH DEPT MAY 0 2 2024
SALEM CITY HALL CiTYOFSALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: LORI WEJBE
Property Address: 20 GALLOWS HILL RD, SALEM,MA 01970
Policy Number: 1623202
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 04/22/2024
Claim Number: 479568
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