5-7 Lussier Street 1-30-20 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108,FAX(800)851-8424
1/31/2020
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139, Sec.313 RECEIVE
FEB 0'6 2020
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: EDWARD LAPHAM
Property Address: 5-7 LUSSIER ST,SALEM, MA 01970
Policy Number: 1382534
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/30/2020
Claim Number: 445632
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