56 Mason Street 9-4-21 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
9/4/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139_ Sec.313 RECEIVED
SEP 0 9 2021
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: LINDSAY WOOD AND GAVIN WOOD
Property Address: 56 MASON ST, SALEM, MA 01970
Policy Number: 1540705
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 08/27/2021
Claim Number: 458137
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 36 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