2 Pierce Avenue 12-2-18 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108.FAX(800)851-8424
1217/2018
Firm of Notice of Casualty Loss to Building RECEIVE.®
Under Mass.Gen.Laws, Ch.139,_Sec.3B
DEC 12 2018
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: TINA BURBINE
Property Address: 2 PIERCE AVE,SALEM, MA 01970
Policy Number: 1016377
Type Loss: All Other Section I Losses
Date of Loss: 12/02/2018
Claim Number: 434381
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, Char;ter 143 section 6 to be applicable. If any
notice under Massachusetts General Laws Cha:ter 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