75 PALMER STREET 6-12-24 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Oniv(800)392-6108, FAX(800)851.8424
6/15/2024
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.3B
SALEM HEALTH DEPT
SALEM CITY HALL
SALEM MA 01970
Re: Insured: LUIS BAEZ AND PAOLA BAEZ
Property Address: 75 PALMER ST, SALEM, MA 01970
Policy Number: 1624280
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 06/12/2024
Claim Number: 480305
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
RECEIVED
JUN 2 4 2024
CITY OF SALEM
BOARD OF HEALTH