1 PAUL AVENUE 4-15-22 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
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 2022
CITY OF SALEM
BOARD OF HEALTH
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: 04/15/2022
Claim Number: 465157
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. Chanter 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