107 BAY VIEW AVENUE 1-6-18 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108, FAX(800)$51.8424
1/912018
Form of Notice of Casualty Loss to Building RECEIVED
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Under Mass Gen Laws Ch.139 Sec.3B JAN 16 2018
CITY OF SALEM
SALEM HEALTH DEPT, BOAFID OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: LINDACLEARY
Property Address: 107 BAYVIEW AVENUE,SALEM, MA 01970
Policy Number: 1445409
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/06/2018
Claim Number: 420904
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