8 Gifford Court 3-3-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108. FAX(800)851.8424
3/6/2018
Form of Notice of Casualty Loss to Building RECEIVED'-
Under Mass Gen. Laws Ch.139, Sec.313
MAR 12 2013
CITY OF SALEM
SALEM HEALTH DEPT. BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MONIQUE NELSON
Property Address: 8 GIFFORD COURT, SALEM, MA 01970
Policy Number: 1338233
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 03/03/2018
Claim Number: 424130
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