162 NORTH STREET 5-7-24 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
5/11/2024
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws.Ch.139, Sec.36
RECEIVED
SALEM HEALTH DEPT. MAY 212024
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: MARY ELLEN MANNING
Property Address: 162 NORTH ST, SALEM, MA 01970
Policy Number: 1136301
Type Loss: Water Damage:Appliance failure
Date of Loss: 05/07/2024
Claim Number: 479781
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