57 - 57.5 Ocean Avenue 8-24-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
8/28/2018
Form of Notire of Casualty Loss to Building EVE 1 V E D
Under Mass. Gen.Laws.Ch.139. Sec.3B
SEP a 12018
SALEM HEALTH DEPT, CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: MICHAEL BRIGGS AND ANDREW SCHWEIHS
Property Address: 57-571/2 OCEAN AVE,SALEM, MA 01970
Policy Number: 1476124
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 08/24/2018
Claim Number: 431783
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