11 March Street 10-16-19 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
10/23/2019
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139,Sec.36
RECEIVED
SALEM HEALTH DEPT, OCT 2 8 2019
SALEM CITY HALL
CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: JOHANE JEAN-BAPTISE AND LUDGER PERSONNA
Property Address: 11 MARCH ST,SALEM,MA 01970
Policy Number: 1461315
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/16/2019
Claim Number: 443613
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, Chanter 139,Section 36 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