66 Highland Avenue 10-27-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(8001392.6108, FAX(800)851-8424
10/29/2019
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws, Ch.139, Sec.313 RECEIVED
SALEM HEALTH DEPT. NOV 0 5 2019
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: DAVID AND CATHLEEN MCCARTHY
Property Address: 66 HIGHLAND AVE, SALEM,MA 01970
Policy Number: 1078754
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/27/2019
Claim Number: 443767
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