9 1/2 INTERVALE ROAD - CLAIM LTR MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108.FAX(800)851-8424
5/13/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.313
SALEM BUILDING COMMISSIONER MAY 18,fgmg: 4
SALEM CITY HALL MAY
SALEM MA 01970
Re: Insured: JAIRO VANEGAS
Property Address: 9 1/2 INTERVALE RD.SALEM, MA 01970
Policy Number: 1420091
Type Loss: All Other Section I Losses
Date of Loss: 01/25/2021
Claim Number: 455699
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 313 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