6 CYPRESS 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
8/19/2021
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: FAKHRI BAKR
Property Address: 6 CYPRESS ST, SALEM, MA 01970
Policy Number: 1380061
Type Loss: Massachusetts Tenant Relocation Expense
Date of Loss: 11/19/2019
Claim Number: 457828
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
AUG 23 PM.2215
AUG