HomeMy WebLinkAboutmold damage cuased by water 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two C€nter Plaza
Boston, Massachusetts 021 08-'l 904
(617) 723-3800 Ma Onlv (800) 392-6108, FAX {800} 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws. Ch.139, Sec.38
5/13/2015
YARMOUTH FIRE DEPT
96 OLD [,,IAIN ST
SOUTH YARI\,,IOUTH IV1A 02664
Re
c1\,tA0002'1
lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
KIN CHUNG LAI\4
22 BURNABY ST.. WEST YARI\4OUTH. MA
1150233
Mold caused by: Water Damage
05t11t2015
339033
02673
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00 or cause l\4assachusetts General . Chaoter 143. section 6 to be applicable. lf any
notice is appropriate, please direct it to the
attention of the writer and include a reference to the captioned insured, location, policy number, date ol loss
and claim or file number.
l\.4PluA Claims Division