4 MARION ROAD_ CLAIM NOTICE 8-13-25 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(6171723.3800 Me Only(8001392.6108.FAX(800)851.8424
8/30/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139, Sec.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: DONNAANAYA
Property Address: 4 MARION ROAD. SALEM, MA 01970
Policy Number: 1231223
Type Loss: Other Causes of consequential Mold
Date of Loss: 08/1312025
Claim Number: 487198
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