Notice of Loss 61323 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
6/17/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
YARMOUTH BUILDING DEPT
1146 ROUTE 28 /l •- '-
SOUTH YARMOUTH MA 02664 JuN23�O`J99
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Re: Insured: JO OCCHIPINTI AND ANN MARIE UHER
Property Address: 11 DAYTON RD., SOUTH YARMOUTH, MA 02664
Policy Number: 0930103
Type Loss: All Other Section I Losses
Date of Loss: 06/13/2023
Claim Number: 473184
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