HomeMy WebLinkAboutClaim of Loss MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
8/21/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139.Sec.3B
RECEIVED
YARMOUTH BUILDING DEPT
1146 ROUTE 28 AIirj 2 4 Zoos
SOUTH YARMOUTH MA 02664
BUILDING DEPARTMENT
By:
Re: Insured: JANET HOSMER
Property Address: 28 SIERRA WAY.WEST YARMOUTH,MA 02673
Policy Number: 1131893
Type Loss: Other Causes of consequential Mold
Date of Loss: 08/01/2018
Claim Number: 431589
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