115-117 Leach Street 7-30-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(8001851-8424
8/17/2019
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass. Gen.Laws, Ch.139,Sec.36
AUG. 2 2 2019
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: GEORGE&CONSTANCE CLAVEAU
Property Address: 115-117 LEACH ST,SALEM, MA 01970
Policy Number: 0669248
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 07/30/2019
Claim Number: 441786
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.
MPI°JA Claims Division
CMA00021