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
9/11/2018
Form of Notice of Casualty Loss to Building
Under Mass. Gen.Laws,Ch.139,Sec.3B
• RECEIVED
YARMOUTH BUILDING DEPT SEP 17 2Q18
1146 ROUTE 28
SOUTH YARMOUTH MA 02664 BUILDING DEPARTMENT
By
Re: Insured: TRACEY WAGNER SMITH
Property Address: 81 JEFFERSON AVENUE,WEST YARMOUTH,MA 02673
Policy Number: 0964906
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 04/30/2018
Claim Number: 432086
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