3 GENEVA STREET 5-9-22 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
5/14/2022
Form of Notice of Casualty Loss to Building RECEIVED
1 InHPr Malts ran laws f h.139 Ser..3B
MAY 19 2022
SALEM HEALTH DEPT. CITY OF SALEM
BOARD OF HEALTH
SALEM CITY HALL
SALEM MA 01970
Re: Insured: JOSE MOYA-CUEVAS
Property Address: 3 GENEVA ST.. SALEM, MA 01970
Policy Number- 1402746
Type Loss: Smoke
Date of Loss: 05/09/2022
Claim Number: 465358
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. Charter 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