37 HANCOCK STREET 5-10-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6171723-3800 Ma Only(800)392-6108.FAX(800)851-8424
5/14/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139, Sec.36 RECEIVED
MAY 2 4 2022
SALEM HEALTH DEPT.
CITY OF SALEM
SALEM CITY HALL BOARD OF HEALTH
SALEM MA 01970
Re: Insured: JUDITH E. MIRABILE
Property Address: 37 HANCOCK STREET,SALEM. MA 01970
Policy Number: 1259667
Type Loss: Fire(including Fire caused by Lightning
Date of Loss: 05/10/2022
Claim Number: 465366
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