60 Mason Street 10-17-18 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
11/1/2018
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass.Gen.Laws, Ch.139, Sec.36
NOV 0 7 2018
CITY OF SALEM
SALEM HEALTH DEPT, BOARD OF HEALT H
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MONIQUE MONTAS
Property Address: 60 MASON ST,SALEM,MA 01970
Policy Number: 0999693
Type Loss: Furnace/Boiler
Date of Loss: 10/17/2018
Claim Number: 433454
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, Chaoter 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