75 Grove Street 3-26-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Me Only(800)392-6108,FAX(800)851.8424
5/2/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
RECEIVED
SALEM HEALTH DEPT. MAY 0 7 Z013
SALEM CITY HALL
CITY OF SALEM
SALEM MA 01970
BOARD OF HEALTH
Re: Insured: JOSE&MARIA SILVA
Property Address: 75 GROVE STREET.SALEM, MA 01970
Policy Number: 0429702
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 03/26/2018
Claim Number: 428758
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
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