62 BEAVER STREET 8-23-19 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITIRG ASSOCIATION
Two Center plaza '
Boston,Massachusetts 0. '08-"04
(6171,723-3800 Ma Only(8001392-61 D" FAA' '600,s�1- C E I V E D
AUG 3, 0 2019 8/27/2019
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313 CITY OF SALEM
BOARD OF HEALTH
SALEM HEALTH DEPT.
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MICHELLE C DESMOND-POST&BRENDON POST
Property Address: 62 BEAVER ST,SALEM. MA 01970
Policy Number: 1055782
Type Loss: Water Damage:All Other Water DamagF.
Date of Loss: 08/23/2019
Claim Number: 441982
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. Cha ter 139 Section 313 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
C MA00021