40 Salem Street 12-23-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108,FAX(800)851-8424
1/1512019
Form of Notice of Casualty Loss to Building RECEIVE®
Under Mass. Gen.Laws,Ch.139,Sec.313
JAN 18 2019
SALEM HEALTH DEPT. BOCITY ARD F SALEM
SALEM CITY HALL
HEALTH
SALEM MA 01970
Re: Insured: DEMETRIUS C MACARTHUR
Property Address: 40 SALEM STREET,SALEM, MA 01970
Policy Number: 0618081
Type Loss: Vandalism,Malicious Mischief
Date of Loss: 12/23/2018
Claim Number: 435012
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, Chaf;ter 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