6 Lemon Street 11-19-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Oniv(800)392-6108,FAX(8001851-8424
12/4/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws. Ch.139 Sec.313 RECEIVED
DEC 0 9 2019
SALEM HEALTH DEPT.
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: CHARLES A FUSI AND GRACE LUK ABONGNELAH
Property Address: 6 LEMON ST.SALEM,MA 01970
Policy Number: 1435671
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 11/19/2019
Claim Number: 444575
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