4 FAIRVIEW AVENUE 6-7-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(6171723.3800 Ma Oniv(800)392-6108,FAX(800)851-8424
6/11/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.313
RECEIVE
SALEM HEALTH DEPT. JUN 17 2022
SALEM CITY HALL CITY OF SALEIvi
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: ALEXANDER V NORTON JR&LISA NORTON
Property Address: 4 FAIRVIEW AVENUE, SALEM, MA 01970
Policy Number: 1247402
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 06/07/2022
Claim Number: 465834
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 Cha,-ter 143 section 6 to be applicable. If any
notice under Massachusetts General Laws. Cha:-)ter 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