93 OCEAN AVENUE 9-5-25 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
9/27/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139. Sec.313
RECEIVED
SALEM HEALTH DEPT.
SALEM CITY HALL OCT 0 6 2025
SALEM MA 01970
CITY OF SALEM
BOARD OF HEALTH
Re: Insured: WILLIAM TWOMEY
Property Address: 93 OCEAN AVE,SALEM, MA 01970
Policy Number: 1720293
Type Loss: Other Physical Damage
Date of Loss: 09/05/2025
Claim Number: 487654
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