38 Dunlap Street 3-27-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetis 02108.1904
(61.71723.3800 Ma Only(800)392-6108, FAX(8001851.8424
3/28/2018
Form of Notice of Casualty Loss to Building �g--a� t
Under Mass. Gen.Laws,Ch.139, Sec.313 RECEIVE®
APR 0 2 2018
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: PAUL A.TREMBLEY
Property Address: 38 DUNLAP STREET.SALEM. MA 01970
Policy Number: 1211873
Type Lass: Water Damage: Plumbing Systems
Date of Loss: 03127/2018
Claim Number: 427328
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