HomeMy WebLinkAboutinsurance claim water damage 6.27.2023MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusefts 02'l 08.1 904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX (800) 851.8424
Form of Notice of Casualty Loss to Building
Under l\4ass. Gen.Ch.139. Sec.38
4t19t202s
YARMOUIH FIRE DEPT
96 OLD MAIN ST
SOUTH YARIVIOUTH MA 02664
KERVENS BLANC AND JEAN FILISME
12 CANVASBACK LN. WEST YARMOUTH. MA
1582292
Water Damage: All Other Water Damage
0612712023
485049
02673
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. Chaoter 143. section 6 to be applicable. lfany
notice under Massachusetts General Laws, Chaoter 139. Section 3B is appropriate, please direct it to the
attention of the wnter and include a reference to the captioned insured, location, policy number, date of loss
and claim or file number.
Ir4PlUA Claims Division
ct\,iAo0021
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number: