4 FAIRVIEW AVENUE 10-27-21 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(8001392.6108, FAX(800)851-8424
1/15/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313
RECEIVE®
SALEM HEALTH DEPT. ,JAN 2 5 2022
SALEM CITY HALL
SALEM MA 01970 CITY Or"6ALEM
BOARD OF HEALTH
Re: Insured: ALEXANDER V NORTON JR&LISA NORTON
Property Address: 4 FAIRVIEW AVENUE, SALEM,MA 01970
Policy Number: 1247402
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/27/2021
Claim Number: 462668
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