162 NORTH STREET 7-20-22 CLAIM (002) MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392.6108,FAX(8001851-8424
7/30/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313
REECEIVED
SALEM HEALTH DEPT.
SALEM CITY HALL AUG 0 5 2022
SALEM MA 01970
CITY OF SALEM
BOARD OF HEALTH
Re: Insured: MARY ELLEN MANNING
Property Address: 162 NORTH ST, SALEM, MA 01970
Policy Number: 1136301
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 07/20/2022
Claim Number: 466640
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, Chaoter 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