10-12 WARD STREET 12-2-25 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
12/6/2025
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139,Sec.313
RECEIVED
SALEM HEALTH DEPT. DEC 112025
SALEM CITY HALL
SALEM MA 01970 CITY OF SALEM
BOARD OF HEALTH
Re: Insured: PETER A. SHOLDS AND MARY F. SHOLDS
Property Address: 10-12 WARD STREET. SALEM, MA 01970
Policy Number: 1355918
Type Loss: Furnace/Boiler
Date of Loss: 12/02/2025
Claim Number: 488733
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