5 Green Street, Unit A MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
1 211 7/20 1 9
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws. Ch.139, Sec.313 RECEIVED
DEC 2 0 2019
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: ELLEN CYR
Property Address: 5 GREEN STREET UNIT A.SALEM,MA 01970
Policy Number: 1226979
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 12/15/2019
Claim Number: 444817
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. ChaAer 143. section 6 to be applicable. If any
notice under Massachusetts General Laws. Cha; ter 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