282 Highland Avenue 3-8-18 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)7233800 Ma Only(800)392.6108.FAX(800)851-8424
3/15/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139. Sec.36 RECEIVED
E^CtVCD
SALEM HEALTH DEPT. MAR 2 12018
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: JEAN M KAZADI AND GERMAINE KADIMA
Property Address: 282 HIGHLAND AVENUE,SALEM,MA 01970
Policy Number: 1079990
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 03/0812018
Claim Number: 426239
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