13 RAVENA AVENUE - CLAIM NOTICE MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Oniv(800)392-6108, FAX(800)851-8424
7/8/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: TERESA BERGANZA
Property Address: 13 RAVENNA AVE, SALEM, MA 01970
Policy Number: 1481986
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 07/06/2021
Claim Number: 456687
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
JUL