Insurance Claim MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
7/15/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
YARMOUTH BUILDING DEPT R E C E i v 7: o ,
1146 ROUTE 28
SOUTH YARMOUTH MA 02664 JUL 19 2023
BUILDING DEPARTMENT
By-
Re: Insured: SHSHANNA WILLIAMS AND GLENN MEWHINEY
Property Address: 2 ANTHONY RD.WEST YARMOUTH, MA 02673
Policy Number: 1617155
Type Loss: Vehicle Damage
Date of Loss: 07/09/2023
Claim Number: 473581
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