30 HANCOCK STREET 6-30-22 CLAIM MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723.3800 Ma Oniv(800)392-6108. FAX(8001851-8424
9/17/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139. Sec.313
RECEIVED
SALEM HEALTH DEPT.
SALEM CITY HALL SEP 2 2 2A22
SALEM MA 01970 CITY OF S",LEM
BOARD OF HEALTH
Re: Insured: SERGIO DESOUZA TRUSTEE OF THE GIFFO REAL
Property Address: 30 HANCOCK ST,SALEM, MA 01970
Policy Number: 1510426
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 06/30/2022
Claim Number: 467498
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