30 Andrew Street 7-10-18 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
12/14/2019
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass.Gen. Laws,Ch.139.Sec.36
DEC 19 2019
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL
BOARD OF HEALTH
SALEM MA 01970
Re: Insured: DONNA CHALUPOWSKI
Property Address: 30 ANDREW ST.SALEM,MA 01970
Policy Number: 1477398
Type Loss: All Other Section I Losses
Date of Loss: 07/10/2018
Claim Number: 444772
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 313 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