189 Lafayette St Unit 2 - Claim Notice MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108.1904
(617)723.3800 Me Only(800)392-6108, FAX(800)851.8424
7/16/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: SORKADH MUSTAFA& IRIDA MUSTAFA
Property Address: 189 LAFAYETTE ST.#2,SALEM. MA 01970
Policy Number: 1390167
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 07/07/2022
Claim Number: 466436
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
20
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