13 Mason Street, Apt. 2 3-2-18 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
3/3/2018
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139, Sec.36 RLECEIVE®
MAR 12 2018
SALEM HEALTH DEPT.
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: RAFAEL LINARES
Property Address: 13 MASON STREET APT 2,SALEM. MA 01970
Policy Number: 1184163
Type Loss: All Other Section I Losses
Date of Loss: 03/02/2018
Claim Number: 422996
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
CMAD0021