186 Lafayette Street 7-24-19 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
3/1/2020
Form of Notice of Casualty Loss to Buildiny
Under Mass.Gen. Laws Ch.139, Sec.313
SALEM HEALTH DEPT RECEIVED
SALEM CITY HALL
SALEM MA 01970 MAR 0.9 2020
CITY OF SALEM
BOARD OF HEALTH
Re: Insured: EMILIA LAZEA
Property Address: 186 LAFAYETTE STREET,SALEM,MA 01970
Policy Number: 1145746
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 07/24/2019
Claim Number: 446288
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