48 Dearborn Street 11-3-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392-6108,FAX(800)851-8424
RECEIVED
1116/2018
Form of Noticc of Casualty Loss to Building
Under Mass.Gen.Laws. Ch.139 Sec.36
NOV 142018
CITY OF SALEM
SALEM HEALTH DEPT. BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: ANTONIO 0&MARIA G SILVA
Property Address: 48 DEARBORN ST,SALEM, MA 01970
Policy Number: 0696464
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 11/03/2018
Claim Number: 433591
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. ChaAer 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