75 Palmer Street 8-23-20 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
8/27/2020
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,_Ch.139 Sec.3B
SALEM HEALTH DEPT.
SALEM CITY HALL RECEIVE
SALEM MA 01970
AUG 312020
CITY OF SALEM
BOARD OF HEALTH
Re: Insured: LUIS BAEZ AND PAULA POL
Property Address: 75 PALMER STREET,SALEM,%1A 01970
Policy Number: 1035408
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 08/23/2020
Claim Number: 450331
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