19 Linden Street 10-16-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(8001392.6108, FAX(8001 851-8424
1117l2019
Form of Notice of Casualty Loss to Building RECEIVE®
Under Mass. Gen.Laws, Ch.139, Sec.3B
NOV 12 2019
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: WILLIAM DRAGON
Property Address: 19 LINDEN ST.,SALEM, MA 01970
Policy Number: 1303494
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/16/2019
Claim Number: 444116
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
ir�ke 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
CP;iFl00021