HomeMy WebLinkAboutice dams 2015MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center 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
5t1312015
YARMOUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARI\IOUTH i/A 02664
lnsured:
Property Address:
Policy Number:
Type Loss:
oate of Loss:
Claim Number:
ADELE PETRONE
94 BROADWAY STREET. WEST YARMOUTH. MA 02673
1178379
lce Dams
03/30/2015
339071
Re
cMA00021
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000,00 or cause l/assachusetts General Laws, 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 of loss
and claim or flle number.
l\.4P1 UA Claims Division