186 LAFAYETTE STREET CLAIM NOTICE MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Me 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.3B
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
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
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