4 Fairview Avenue - Claim Notice MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Ma Only(8001392.6108.FAX(800)851-8424
6/11/2022
Form of Notice of Casualty Loss to Building
Under Mass Gen Laws Ch.139 Sec.38
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
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: 06/0712022
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 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
I