Notice of Loss 71903 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723-3800 Ma Only(8001392-6108.FAX(8001 851-8424
8/5/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws,Ch.139, Sec.3B
YARMOUTH BUILDING DEPT
1146 ROUTE 28
SOUTH YARMOUTH MA 02664
Re: Insured: JOHN P SWEKLO&CHRISTINE B SWEKLO
Property Address: 10 EVERGREEN ROAD,WEST YARMOUTH, MA 02673
Policy Number: 1356805
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 07/19/2023
Claim Number: 474167
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 „ R v E D
F
I. i AUG 10 2023
BUILDING DEPARTMENT