48 RAYMOND ROAD 2-15-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108. FAX(800)851-8424
2/19/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.313
RECEIVE®
SALEM HEALTH DEPT. FEB 2 8 Z0ZZ
SALEM CITY HALL
SALEM MA 01970 CITY OF SALEM
BOARD OF HEALTH
Re: Insured: GINO FUSCO AND JESSE FUSCO
Property Address: 48 RAYMOND RD,SALEM, MA 01970
Policy Number: 1503223
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 02/15/2022
Claim Number: 463728
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::ter 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