HomeMy WebLinkAboutClaim of Loss MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723-3800 Ma Only(8001 392-6108.FAX(8001 851.8424
12/12/2018
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: CINDY SMITH
Property Address: 455 WINSLOW GREY ROAD.SOUTH YARMOUTH.MA 02664
Policy Number: 1357946
Type Loss: All Other Section I Losses
Date of Loss: 12/07/2018
Claim Number: 434466
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
j GEC 17 2016
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