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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424
10124/2018
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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: ANNE MARIE BERRY
Property Address: 379 ROUTE 6A.YARMOUTHPORT,MA 02675
Policy Number: 1230608
Type Loss: Water Damage:Plumbing Systems
Date of Loss: 10/12/2018
Claim Number: 433211
Claim has been made involving loss,damage or destruction of the above captioned properly,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