Notice of Loss 62822 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(6171 723-3800 Ma Only(8001392.6108, FAX(800)851-8424
7/2/2022
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B r
EINED
YARMOUTH BUILDING DEPT 4 2O2Z
1146 ROUTE 28 JUL 1
SOUTH YARMOUTH MA 02664
BUIt DING DEPARTMENT
Re: Insured: NANCY R. HEARST&ELLEN H. GILMAN
Property Address: 57 GLEASON AVE,WEST YARMOUTH, MA 02673
Policy Number: 1063725
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 06/28/2022
Claim Number: 466177
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