51 Lafayette Street 3-9-21 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Onlv(800)392-6108,FAX(800)851-8424
5/13/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139 Sec.313 RECEIVED
SALEM HEALTH DEPT. MAY 17 2021
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: RICHARD BUCHANAN AND LAURIE BUCHANAN
Property Address: 51 LAFAYETTE ST UNIT 508, SALEM, MA 01970
Policy Number: 1297001
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 03/09/2021
Claim Number: 455698
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