Claim of Loss - 8/2/2018 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
'Boston,Massachusetts 02108-1904
(6171723.3800 Ma Only(8001392.6108,FAX(8001 851-8424
8/2/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.3B
YARMOUTH BUILDING DEPT
1146 ROUTE 28
SOUTH YARMOUTH MA 02664
Re: Insured: ANTHONY AND SHARON SPIGNESE
Property Address: 61 CAPTAIN BESSE RD.SOUTH YARMOUTH,MA 02664
Policy Number: 0894946
Type Loss: Other Causes of consequential Mold
Date of Loss: 07/15/2018
Claim Number: 430977
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
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CMA00021