56 MASON STREET 9-22-22 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
10/1/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch.139 Sec.313
SALEM HEALTH DEPT
SALEM CITY HALL
SALEM MA 01970
Re: Insured: LINDSAY WOOD AND GAVIN WOOD
Property Address: 56 MASON ST, SALEM, MA 01970
Policy Number: 1540705
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 09/22/2022
Claim Number: 467741
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
RECEIVED
OCT 0 7 2022
CITY OF SALEM
BOARD OF HEALTH