HomeMy WebLinkAboutClaim of Loss MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(6171723.3800 Ma Only(8001 392-6108,FAX(8001 851-8424
12/14/2018
Form of Notice of Casualty Loss to Building
Under Mass.Gen.Laws,Ch.139,Sec.38
17: 1C.. G L.- �'.1 ..
YARMOUTH BUILDING DEPT .
1146 ROUTE 28 I i DEC 19 2013
SOUTH YARMOUTH MA 02664 _
. NG DEPA ": r':EPII' '.
Re: Insured: STEPHEN PETERSON
Property Address: 11 OLIVER ST,SOUTH YARMOUTH,MA 02664
Policy Number: 0962633
Type Loss: All Other Section I Losses
Date of Loss: 12/10/2018
Claim Number: 434503
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.
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. MPIUA Claims Division
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CMA00021