2022 Property Loss Notice MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108. FAX(800)851-8424
10/8/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139,Sec.3B
YARMOUTH HEALTH DEPT
1146 ROUTE 28
SOUTH YARMOUTH MA 02664
Re: Insured: AHMED SHAHIN
Property Address: 25 CAMP ST.WEST YARMOUTH, MA 02673
Policy Number: 1501769
Type Loss: Windstorm Other than Hurricane or Tornad
Date of Loss: 10/02/2022
Claim Number: 467844
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
OCT 13 2022
HEALTH DEPT.