1 PAUL AVENUE 3-18-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Onlv(800)392-6108, FAX(800)851.8424
4/30/2022
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws. Ch.139. Sec.313
SALEM HEALTH DEPT. RECEIVED
SALEM CITY HALL
SALEM MA 01970 MAY 0 9 2022
C17 Y OF LE
BOARD OF HEA TH
Re: Insured: RAPHAEL H LUNARDI
Property Address: 1 PAUL AVE,SALEM, MA 01970
Policy Number: 1445123
Type Loss: All Other Section I Losses
Date of Loss: 03/18/2022
Claim Number: 465158
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 313 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