22 Sable Road 6-1-21 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6171723-3800 Ma Only(800)392-6108,FAX(800)851-8424
6/3/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.313 RECEIVED
SALEM HEALTH DEPT. JUN U 8 2021
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: CHRISTOPHER J CARROLL AND KERRI HOWARD
Property Address: 22 SABLE RD, SALEM, MA 01970
Policy Number: 1478164
Type Loss: Other Causes of consequential Mold
Date of Loss: 06/01/2021
Claim Number: 456048
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