11 CHURCH STREET, #507 3-13-18 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02103-1904
(617)723.3800 Ma Only(800)392.6108, FAX(8001851.8424
RECEIVED
Form of Notice of Casualty Loss to Building
Under Mass. Gen.Laws,Ch.139,Sec.313 JUN 0 6 2018
CITY OF SALEM
SALEM HEALTH DEPT. BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: insured: MARYZAWACKI
Property Address: 11 CHURCH STREET#507,SALEM.MA 01970
Policy Number: 1248909
Type Loss: Windstorm Other than Hurricane or?orna_d
Date of Loss: 03/13/2018
Claim Number: 429522
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