21-23 Shore Avenue 10-17-19 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
10/22/2019
Form of Notice of Casualty Less to Building
Under Mass. Gen.Laws. Ch.139, sec.3B RECEIVED
OCT 282019
SALEM HEALTH DEPT.
SALEM CITY HALL CITY OF SALEM
BOARD OF HEALTH
SALEM MA 01970
Re: Insured: MARIE C. KAWCZYNSKI &CAROL CARTER
Property Address: 21-23 SHORE AVE., SALEM,MA 01970
Policy Number: 0438852
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/17/2019
Claim Number: 443547
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