HomeMy WebLinkAboutwater damage 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02'l 08.1904
{617) 723.3800 Ma Onlv (8001 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass, Gen. Laws, Ch.139, Sec.3B
5/6/2015
YARMOUTH FIRE DEPT
96 OLD IVAIN ST
SOUTH YARMOUTH MA 02664
lnsured:
Property Address:
Policy Number:
Type Loss:
oate of Loss:
Claim Numbor:
JEFFREY M. SOUSA
2 ASH ROAO, SOUTH YARI/OUTH, MA
0861713
Water oamage: All Other Water Damage
05/04i2015
338700
Re
cMA00021
02664
Claim has been made involving loss, damage or destruction of the above captioned property, which may eitherexceed$1000.00orcaUse@tobeapp|icable.|fany
notice 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.
i,,lPlUA Claims Division