12 BOARDMAN STREET UNIT 3 - CLAIM NOTICE MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Oniv(8001392-6108. FAX(800)851-8424
4/13/2021
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws. Ch.139 Sec.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: HANG(CATHERINE)NGUYEN
Property Address: 12 BOARDMAN STREET, UNIT#3,SALEM, MA 01970
Policy Number: 1179945
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/02/2021
Claim Number: 455120
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
APR 20Pm4:49
APR