28 PHILLIPS STREET - 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
10/31/2021
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139 Sec.313
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: JENNIFER CROWE TRUSTEE OF 28 PILLIPS STIR
Property Address: 28 PHILLIPS ST,SALEM, MA 01970
Policy Number: 1572785
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/26/2021
Claim Number: 459710
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. Cha;Aer 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
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