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20 CONANT STREET 1-27-18 CLAIM
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Ceoter Plaza Boston,Massachusetts 02108-1904 (617)723.3800 Ma Only(800)392.6108,FAX(800)851.8424 1/30/2018 Form of Notice of Casualty Loss to Building Under Mass. Gen.Laws, Ch.139, SPC.3B RECEIVED FEB © 2 2018 SALEM HEALTH DEPT. CITY OF SALEM SALEM CITY HALL BOARD HEALTH SALEM MA 01970 Re: Insured: ELLEN PEROCCHi Property Address: 20 CONANT STREET,SALEM, MA 01970 Policy Number: 1424195 Type Loss: Furnace/Boiler Date of Loss: 01/27/2018 Claim Number: 422174 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,loration, policy number,date of loss and claim or file number. NIPIUA Claims Division CMA00021