6 Loring Hills Avenue MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(8001851-8424
6/4/2019
Form of Notice of Casualty Loss to Building
Under Mass_Gen.Laws, Ch.139.Sec.3B
SALEM HEALTH DEPT
SALEM CITY HALL
SALEM MA 01970
Re: Insured: LAWRENCE DITHOMAS AND MARY DITHOMAS
Property Address: 6 LORING HILLS AVE,SALEM,MA 01970
Policy Number: 1510599
Type Loss: Water Damage:Plumbing Systems
Date of Loss: 06/01/2019
Claim Number: 438702
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