84 FLINT STREET 8-24-22 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
9/3/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139 Sec.3B
RECEIVED
SALEM HEALTH DEPT. SEP O 8 2022
SALEM CITY HALL
SALEM MA 01970 CITY OF SALEM
BOARD OF HEALTH
Re: Insured: RAYMOND HARVEY
Property Address: 84 FLINT ST, SALEM, MA 01970
Policy Number- 1560520
Type Loss: Water Damage: Plumbing Systems
Date of Loss: 08/24/2022
Claim Number: 467236
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