HomeMy WebLinkAboutwater damage 2015MASSACHUSETTS PROPERTY INSURANCE UNOERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 021 08-1904
(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.3B
5t13t2015
YARI,4OUTH FIRE DEPT
96 OLD MAIN ST
SOUTH YARI/OUTH MA 02664
Re: lnsured:
Property Address:
Policy Number:
Type Loss:
Date of Loss:
Claim Number:
DAVID G RICH
71 CAPTAIN BESSE RD. SOUTH YARMOUTH, MA
0778634
Water Damage: All Other Water Damage
0312812015
339069
02664
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed$1000'00orcaUSe@tobeapp|icab|e.lfany
notice under Massachusetts General Laws. Chapter 139. Sectjon 3B is appropnate, please direct it to the
attention of the writer and include a reference to the captioned insured, Iocation, policy number, date of loss
and claim or file number.
MPIUA Claims Division
cn1A00021