HomeMy WebLinkAboutNotice of Loss 11123 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
1/14/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
YARMOUTH BUILDING DEPT R E C E
1146 ROUTE 28
SOUTH YARMOUTH MA 02664 I A ti "3 2:73
JI , NCI •.Y�.�
BUILDING DEFAR-IMENT
Re: Insured: RICHARD GRIBKO
Property Address: 6 BAKER AVE,WEST YARMOUTH, MA 02673
Policy Number: 1477027
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 01/11/2023
Claim Number: 469601
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