48 Raymond Road - Claim Notice 21922 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(8001392-6108. FAX(800)851.8424
2/19/2022
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: 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, 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
FEB F>O4.Li
FEE,I-L�