42 Essex Street 3R - Claim Notice MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(6171723.3800 Ma Only(8001392.6108. FAX(800)851.8424
5/14/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen, Laws Ch.139, Sec.36
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: MEREDITH BAKER
Property Address: 42 ESSEX ST 3R. SALEM, MA 01970
Policy Number: 1464979
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 05/05/2022
Claim Number: 465365
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
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