12 BOARDMAN STREET 4-2-21 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
4/13/2021
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws, Ch.139, Sec.313
RECEIVED
SALEM HEALTH DEPT. APR 2 U 2021
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: HANG(CATHERINE)NGUYEN
Property Address: 12 BOARDMAN STREET, UNIT#3.SALEM, MA 01970
Policy Number: 1179945
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/02/2021
Claim Number: 455120
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