34 Upham Street 10-17-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108. FAX(800)851-8424
10/18/2019
Form of Notice of Casualty Loss to Building REC'.FNED
Under Mass. Gen. Laws, Ch.139, Sec.313
OCT 2 42019
CITY OF SALEM
SALEM HEALTH DEPT. BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: BYRON&DONNA LOCKE
Property Address: 34 UPHAM STREET,SALEM, MA 01970
Policy Number: 1196172
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/17/2019
Claim Number: 443051
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