8 RICE STREET 1-17-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Ma Onlv(8001392-6108, FAX(800)851-8424
1/29/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139_ Sec.313 RECEIVED
FEB 0 7 2022
SALEM HEALTH DEPT.
SALEM CITY HALL CITY OF 'itila.LN1
BOARD OF HE;4.TH
SALEM MA 01970
Re: Insured: YESENIA RIVERIA
Property Address: 8 RICE ST, SALEM, MA 01970
Policy Number: 1551356
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/17/2022
Claim Number: 463053
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. Chatter 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