57 OCEAN AVENUE 1-4-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
1/8/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139, Sec.313
RECEIVED
SALEM HEALTH DEPT. JAN 13 2022
SALEM CITY HALL
SALEM MA 01970 GI'rY OF SALEM
BOARD OF HEALTH
Re: Insured: MICHAEL BRIGGS AND ANDREW SCHWEIHS
Property Address: 57-57 1/2 OCEAN AVE,SALEM, MA 01970
Policy Number: 1476124
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 01/04/2022
Claim Number: 462594
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