3 Geneva Street - Claim Notice MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(800)392.6108.FAX(8001851.8424
5/14/2022
Form of Notice of Casualty Loss to Building
Under Mass Gen Laws Ch.139, Sec.3B
SALEM BUILDING COMMISSIONER
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 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
pry V