162 NORTH STREET 7-7-24 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
7/27/2024
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139,Sec,313
SALEM HEALTH DEPT.
SALEM CITY HALL
SALEM MA 01970
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: 07/07/2024
Claim Number: 481005
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
AUK ® 2024
SALEM
4Y