Notice of Loss 012223 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617)723-3800 Ma Only(800)392-6108, FAX(800)851-8424
1/27/2024
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: DOREEN LEVITAN
Property Address: 554 FOREST RD,WEST YARMOUTH, MA 02673
Policy Number: 1557174
Type Loss: Water Damage:All Other Water Damage
Date of Loss: 01/22/2023
Claim Number: 477941
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
RECiry - o
[ FEB 012024
CMA00021 .._
BUILDING DEPARTMENT
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