7-13-18 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
7/7/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B RECEIVED
SALEM HEALTH DEPT. JUL 13 2018
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
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: 06/24/2018
Claim Number: 430388
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 Chanter 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