186 LAFAYETTE STREET 3-27-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723-3800 Ma Only(800)392-6108, FAX(800)851-8424
4/2/2022
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws Ch.139. Sec.313 RECEIVED
APR 0 7 2022
SALEM HEALTH DEPT
CITY OF SALEM
SALEM CITY HALL
BOARD OF HEALTH
SALEM MA 01970
Re: Insured: EMILIA LAZEA
Property Address: 186 LAFAYETTE STREET, SALEM, MA 01970
Policy Number: 1145746
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 03/27/2022
Claim Number: 464548
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