28 Phillips Street 10-26-21 claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Oniv(800)392-6108, FAX(800)851-8424
10/31/2021
Form of Notice of Casualty Loss to Building RECEIVED
Under Mass.Gen. Laws, Ch.139, Sec.36
NOV 16 2021
SALEM HEALTH DEPT. CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: JENNIFER CROWE TRUSTEE OF 28 PILLIPS STIR
Property Address: 28 PHILLIPS ST,SALEM, MA 01970
Policy Number: 1572785
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/26/2021
Claim Number: 459710
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,Cha_:ter 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