1-16-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(611)7233800 Ma Onlv(800)392.6108. FAX(800) 851-8424
1/10/2018
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen. Laws Ch 139 V
Sec313
JAN 16 2018
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: JUDITH AMES AND CARRIE AMES RICHARDSON
Property Address: 20 PLANTERS ST, SALEM, MA 01970
Policy Number: 1345538
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 01/09/2018
Claim Number: 421325
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