289 ESSEX STREET 8-2-24 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
9/21/2024
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen. Laws. Ch.139. Sec.3B
SEP 2 6 2024
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: TIM LEAVITT
Property Address: 289 ESSEX ST APT 213, SALEM, MA 01970
Policy Number: 1516496
Type Loss: Other Physical Damage
Date of Loss: 08/02/2024
Claim Number: 481795
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 313 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