4 BENTLEY ST_ NOTICE OF LOSS 9-28-25 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Ma Only(800)392.6108,FAX(800)851.8424 10/412025
Form of Notice of Casualty Loss to Building
Under Mass. Gen.Laws Ch.139 Sec.36
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MARY MELESKI
Property Address: 4 BENTLEY ST.SALEM.MA 01970
Policy Number: 1539159
Type Loss: All Other Section I Losses
Date of Loss: 09/28/2025
Claim Number: 487825
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