HomeMy WebLinkAboutNotice of Loss 062723 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
7/1/2023
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.3B
RFr*F1
D
YARMOUTH BUILDING DEPT
1146 ROUTE 28 0 7 2023
SOUTH YARMOUTH MA 02664
�EUILD1NG DEPARTMENT
y:_
Re: Insured: J SCOTT MARTIN TRUSTEE OF
Property Address: 6 WILLOW LN, S YARMOUTH, MA 02664
Policy Number: 1588416
Type Loss: Water Damage, All Other Water Damage
Date of Loss: 06/27/2023
Claim Number: 473345
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