40 Phillips Street 5-21-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Oniv(800)392-6108,FAX(8001851-8424
5/22/2019
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass.Gen. Laws, Ch.139. Sec.3B
MAY 2 9 2019
SALEM HEALTH DEPT CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: PATRICIA LOBAO
Property Address: 40 PHILLIPS ST.SALEM,MA 01970
Policy Number: 1487262
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 05/21/2019
Claim Number: 438443
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