185 Lafayette Street 8-8-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723.3800 Ma Only(8001392-6108.FAX(800)851-8424
E-CIVE®8/2812018
Form of Nc ce of Casualty Loss to Building
Under Mass. Gen.Laws Ch.139, Sec.313 SEP ® � 2Q1�
CITY OF SALEM
t3OARD OF HEALTH
SALEM HEALTH DEPT
SALEM CITY HALL
SALEM MA 01970
Re: Insured: CANDACE HAREWOOD
Property Address: 185 LAFAYETTE ST.SALEM,MA 01970
Policy Number: 1482517
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 08/08/2018
Claim Number: 431797
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. Charter 143. section 6 to be applicable. If any
notice under Massachusetts General Laws. Chapter 139. Section 313 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
GMA00021