Notice of Loss 2323 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424
2/18/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
YARMOUTH BUILDING DEPT
1146 ROUTE 28
RECSOUTH YARMOUTH MA 02664 V D
FEB 2 4 2023
BUILDING DEPARTMENT
By:
Re: Insured:
JEFFREY J HART
Property Address: 48 TALL PINES DRIVE,YARMOUTH, MA 02675-2517
Policy Number: 0758088
Type Loss: Other Causes of consequential Mold
Date of Loss: 02/03/2023
Claim Number: 471179
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