6 Walter Street 12-31-17 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Only(800)392.6108,FAX(8001851-8424
1/3/2018
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen. Laws, Ch.139, Sec.3B
JAN 0 9 2013
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: ELEANOR ROUNDS
Property Address: 6 WALTER ST.,SALEM. MA 01970
Policy Number: 1348631
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 12/31/2017
Claim Number: 420480
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed`ti1000.00 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