13 Ravenna Avenue 7-6-21 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Onlv(800)392-6108, FAX(800)851.8424
7/8/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.3B RECEIVE
JUL 12 2021
SALEM HEALTH DEPT CITY OF SALEM
CITY HALL SALEM MA 01970 BOARD OF HEALTH
Re: Insured: TERESA BERGANZA
Property Address: 13 RAVENNA AVE,SALEM, MA 01970
Policy Number: 1481986
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 07/06/2021
Claim Number: 456687
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