56 MASON STREET - CLAIM NOTICE MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108. FAX(8001851-8424
9/4/2021
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: LINDSAY WOOD AND GAVIN WOOD
Property Address: 56 MASON ST, SALEM, MA 01970
Policy Number: 1540705
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 08/27/2021
Claim Number: 458137
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 313 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
STEP