HomeMy WebLinkAboutNotice of Loss 9523 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
9/9/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
I
YARMOUTH BUILDING DEPT rECEED
V
1146 ROUTE 28LSEP 13 2023
SOUTH YARMOUTH MA 02664
BUILDING DEPARTMENT
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Re: Insured: DAVID BLAKE AND MICHELLE BLAKE
Property Address: 33 CLEAR BROOK RD.,WEST YARMOUTH, MA 02673
Policy Number: 1349322
Type Loss: Mold caused by:Water Damage
Date of Loss: 09/05/2023
Claim Number: 474876
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