17 BEAVER STREET 8-12-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Only(800)392.6108, FAX(800)851-8424
8/20/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139. Sec.313 RECEIVED
SALEM HEALTH DEPT AUG 2 5 2022
SALEM CITY HALL CITY OF SALEM
SALEM MA 01970 BOARD OF HEALTH
Re: Insured: PATRICK CHEEVER
Property Address: 17 BEAVER ST, SALEM, MA 01970
Policy Number: 1588876
Type Loss: Vehicle Damage
Date of Loss: 08/12/2022
Claim Number: 466994
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