4 Marion Road 8-13-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108.FAX(8001851-8424
8/18/2020
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139 Sec.36 RECEIVED
SALEM HEALTH DEPT. A U G 2 12020
CITY OF SALEM
SALEM CITY HALL BOAR OF HEALTH
SALEM MA 01970
Re: Insured: DONNA ANAYA
Property Address: 4 MARION ROAD, SALEM, MA 01970
Policy Number: 1231223
Type Loss: All Other Section I Losses
Date of Loss: 08/13/2018
Claim Number: 450116
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