16 Summit Street 1-17-21 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
1/21/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.313
RECEIVE®
SALEM HEALTH DEPT. JAN 2 5 2021
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: MARIA SILVA AND VICTOR LIMA
Property Address: 16 SUMMIT ST,SALEM, MA 01970
Policy Number: 1458385
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 01/17/2021
Claim Number: 453512
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. Chanter 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