22 Sable Road 1-1-20 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108.FAX(8001851-8424
1/3/2020
Form of Notice of Casualty Loss to Building ,`
Under Mass.Gen.Laws, Ch.139,Sec.3B RECEIVE
JAN 0 9 2020
SALEM HEALTH DEPT.
CITY 01=SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: CHRISTOPHER J CARROLL AND KERRI HOWARD
Property Address: 22 SABLE RD,SALEM,MA 01970
Policy Number: 1478164
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 01/01/2020
Claim Number: 445115
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