6 CYPRESS STREET - CLAIM NOTICE (002) MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
5/11/2021
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: FAKHRI BAKR
Property Address: 6 CYPRESS ST, SALEM, MA 01970
Policy Number: 1380061
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 05/07/2021
Claim Number: 455607
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